Provider Demographics
NPI:1083835102
Name:TOTAL VISION CENTERS, INC
Entity Type:Organization
Organization Name:TOTAL VISION CENTERS, INC
Other - Org Name:TOTAL VISION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUBRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-845-0751
Mailing Address - Street 1:102 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1417
Mailing Address - Country:US
Mailing Address - Phone:937-845-0751
Mailing Address - Fax:937-845-2931
Practice Address - Street 1:102 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1417
Practice Address - Country:US
Practice Address - Phone:937-845-0751
Practice Address - Fax:937-845-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2703152WC0802X
OH5397152WC0802X
OH5508152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1205815065OtherNPI# DR. DUBRO
OH1710966585OtherNPI# DR. KUHN
OH2341504Medicaid
OH2341504Medicaid
OH9347672Medicare PIN
OH1205815065OtherNPI# DR. DUBRO
OH9347671Medicare PIN
OHTO9347671Medicare PIN