Vision Gallery 417 LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

VISION GALLERY 417 LLC

Practice address

1961 S Glenstone Ave
Springfield, MO 65804-2304

Phone

(417) 323-2448

NPI assigned

Nov 18, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Summer Williamson, ODNPI 1447400668

Title

Sole Member

Phone

(417) 323-2448

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Summer Williamson

  • Optometrist
  • Little Rock Air Force Base, AR
  • NPI 1447400668

  MO

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1144045808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2042 S CELEBRATION AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658093529",
            "telephone_number": "417-323-2448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 S GLENSTONE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042304",
            "telephone_number": "417-323-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION GALLERY 417 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "417-323-2448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maranda Lee Vincent, RN
• Stacy Vincent, PA
• Valerie Lynn Vinson, LMSW
• Narius Aresh Virji, MD
• Vision Clinic PC
• Vision Rehabiliation Center of the Ozarks
• Vision Rehabilitation Center of the Ozarks
• Vision Rehabilitation Center of the Ozarks
• Visionworks Inc (Visionworks)
• Heather Nicole Visser, LMSW

• Optometrist in Springfield, MO
• Providers in Springfield, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.