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Application Process (All Sections MUST be completed):
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1. Fill out one copy of the "Office Information" section of the Vision Care
Provider Application for each of your office locations.
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2. Fill out a separate copy of the "Practitioner Information" section of the
Vision Care Provider Application for each licensed practitioner in your office
that will be providing covered services to Davis Vision members.
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3. Complete a separate copy of the "Payee Information" section of the Vision
Care Provider Application and a W-9 form for each entity that is to receive
reimbursement for covered services rendered at your office.
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4. Use the "Provider Documents Requirement" Checklist to make sure that
copies of all necessary documents are included with your returned,
completed application.
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5. Review and sign the Letter of Agreement for return with the application.
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6. Upon receipt of the completed Vision Care Provider Application and
necessary documentation by Davis Vision the credentialing process will be
initiated. You will be notified of your credentialing status within 90 days of
receipt of the completed application.
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