Provider Demographics
NPI:1033128590
Name:WESTGATE VISION CENTER LLC
Entity Type:Organization
Organization Name:WESTGATE VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HOHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-474-8833
Mailing Address - Street 1:4011 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4266
Mailing Address - Country:US
Mailing Address - Phone:419-474-8833
Mailing Address - Fax:419-474-8943
Practice Address - Street 1:4011 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4266
Practice Address - Country:US
Practice Address - Phone:419-474-8833
Practice Address - Fax:419-474-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3662 T390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2443270Medicaid
OH6081010001Medicare NSC
OH2443270Medicaid