Provider Demographics
NPI:1114959137
Name:AKRON GENERAL'S VISION CENTER
Entity Type:Organization
Organization Name:AKRON GENERAL'S VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE BUSINESS OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:PO BOX 715147
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5147
Mailing Address - Country:US
Mailing Address - Phone:330-344-3583
Mailing Address - Fax:330-996-2930
Practice Address - Street 1:676 S BROADWAY ST
Practice Address - Street 2:STE. 202
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1059
Practice Address - Country:US
Practice Address - Phone:330-344-2020
Practice Address - Fax:330-344-4111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARTNERS PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1750361416OtherDR FLOWER INDIVIDUAL NPI NUMBER
OHFL0424205OtherDR FLOWER MEDICARE INDIVIDUAL NUMBER
OH9351561Medicare PIN
OHFL0424205OtherDR FLOWER MEDICARE INDIVIDUAL NUMBER