Provider Demographics
NPI:1255416137
Name:VISION HEALTH CARE, INC.
Entity type:Organization
Organization Name:VISION HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-366-3830
Mailing Address - Street 1:717 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-5135
Mailing Address - Country:US
Mailing Address - Phone:304-366-3830
Mailing Address - Fax:304-366-8049
Practice Address - Street 1:717 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-5135
Practice Address - Country:US
Practice Address - Phone:304-366-3830
Practice Address - Fax:304-366-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV853-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709527OtherBLUE CROSS NUMBER
WV3810004366Medicaid
WV3810004366Medicaid