Provider Demographics
NPI:1033258900
Name:IRONTON VISION CENTER, INC.
Entity Type:Organization
Organization Name:IRONTON VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLESON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:740-532-2020
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0643
Mailing Address - Country:US
Mailing Address - Phone:740-532-2020
Mailing Address - Fax:740-532-0176
Practice Address - Street 1:220 S 6TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1623
Practice Address - Country:US
Practice Address - Phone:740-532-2020
Practice Address - Fax:740-532-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0047887Medicaid
OH0414660001Medicare NSC
OH0047887Medicaid