NPIMap

Organization Active NPI

Vance Vision Clinic PA

  • Optometrist
  • Cotter, AR
National Provider Identifier
1114224201
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2657 Issued in AR
Legal business name
VANCE VISION CLINIC PA
Practice address
1200 W Main St
Suite 4
Cotter, AR 72626-9777
Phone
(870) 435-3333
Fax
(870) 435-1333
NPI assigned
Feb 25, 2011
Last updated
Mar 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dustin C Vance, O.D.NPI 1235445297
Title
Owner/Doctor
Phone
(573) 382-2974

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2657 AR Primary

Addresses

Primary practice location

1200 W Main St
Suite 4
Cotter, AR 72626-9777

Mailing address

1200 W Main St
Suite 4
Cotter, AR 72626-9777
Phone (870) 435-3333

Other identifiers 1

IdentifierTypeStateIssuer
187164722MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110330000401 AR Part B Supplier - Clinic/Group Practice 3375726219 Receives reassigned benefits from 3 practitioners
Practice locations: Gassville, AR
O20140204001420 AR DME Supplier - Physician - Optometrist 3375726219 Practice locations: Gassville, AR

National Provider Directory

National Provider Directory

Locations

1200 W Main St
#4
Cotter, AR 72626
Phone (870) 232-5315

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1114224201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MAIN ST",
            "address_2": "SUITE 4",
            "city": "COTTER",
            "state": "AR",
            "postal_code": "726269777",
            "telephone_number": "870-435-3333",
            "fax_number": "870-435-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W MAIN ST",
            "address_2": "SUITE 4",
            "city": "COTTER",
            "state": "AR",
            "postal_code": "726269777",
            "telephone_number": "870-435-3333",
            "fax_number": "870-435-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCE VISION CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-25",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "573-382-2974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187164722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cotter, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.