Provider Demographics
NPI:1154488963
Name:COLE VISION CORPORATION
Entity Type:Organization
Organization Name:COLE VISION CORPORATION
Other - Org Name:SEARS OPTICAL #C0319
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:3919 LAFAYETTE RD
Mailing Address - Street 2:LAFAYETTE SQ #400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2531
Mailing Address - Country:US
Mailing Address - Phone:317-328-6455
Mailing Address - Fax:
Practice Address - Street 1:3919 LAFAYETTE RD
Practice Address - Street 2:LAFAYETTE SQ #400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2531
Practice Address - Country:US
Practice Address - Phone:317-328-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0507950018Medicare NSC