Provider Demographics
NPI:1902949654
Name:VISION ONE
Entity Type:Organization
Organization Name:VISION ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-227-2451
Mailing Address - Street 1:1133 ST. VINCENT AVE. #216
Mailing Address - Street 2:SUITE 120 MALL ST. VINCENT
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4147
Mailing Address - Country:US
Mailing Address - Phone:318-227-2451
Mailing Address - Fax:318-227-2442
Practice Address - Street 1:1133 ST. VINCENT AVE #216
Practice Address - Street 2:SUITE 120 MALL ST. VINCENT
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4147
Practice Address - Country:US
Practice Address - Phone:318-227-2451
Practice Address - Fax:318-227-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier