Provider Demographics
NPI:1013185271
Name:PROCARE VISION ENTER
Entity Type:Organization
Organization Name:PROCARE VISION ENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:D.D.
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-363-0787
Mailing Address - Street 1:1155 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2713
Mailing Address - Country:US
Mailing Address - Phone:740-363-0787
Mailing Address - Fax:740-363-2927
Practice Address - Street 1:1155 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2713
Practice Address - Country:US
Practice Address - Phone:740-363-0787
Practice Address - Fax:740-363-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3848332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0832180001Medicare UPIN
OH0832180001Medicare NSC