Provider Demographics
NPI:1003975327
Name:HOMETOWN VISION CENTER INC
Entity Type:Organization
Organization Name:HOMETOWN VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-224-2141
Mailing Address - Street 1:6427 S MAIN ST
Mailing Address - Street 2:P.O. BOX 509
Mailing Address - City:NORTH KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44068-0509
Mailing Address - Country:US
Mailing Address - Phone:440-224-2141
Mailing Address - Fax:440-224-2436
Practice Address - Street 1:6427 S MAIN ST
Practice Address - Street 2:
Practice Address - City:N KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44068-0509
Practice Address - Country:US
Practice Address - Phone:440-224-2141
Practice Address - Fax:440-224-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04039165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH60054OtherAETNA
OH285641915009OtherMEDICAL MUTUAL
OH0518596Medicaid
OH410001554OtherRAILROAD MEDICARE
OH000000282169OtherANTHEM BLUE CROSS
OH000000282169OtherANTHEM BLUE CROSS
OH=========OtherUNITED HEALTHCARE
OH410001554OtherRAILROAD MEDICARE
OH=========OtherVISION SERVICE PLAN
OH=========OtherUNITED HEALTHCARE
OH60054OtherAETNA