Provider Demographics
NPI:1083917819
Name:PROCARE VISION CENTER, LLC
Entity Type:Organization
Organization Name:PROCARE VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:LARAINE
Authorized Official - Last Name:SPROUT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-374-3937
Mailing Address - Street 1:316 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2919
Mailing Address - Country:US
Mailing Address - Phone:740-374-3937
Mailing Address - Fax:740-376-9437
Practice Address - Street 1:316 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2919
Practice Address - Country:US
Practice Address - Phone:740-374-3937
Practice Address - Fax:740-376-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5542261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care