Provider Demographics
NPI:1225461544
Name:GRACE VISION, LLC
Entity Type:Organization
Organization Name:GRACE VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-946-8205
Mailing Address - Street 1:6007 WOODBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9240
Mailing Address - Country:US
Mailing Address - Phone:614-946-8205
Mailing Address - Fax:
Practice Address - Street 1:2314 TAYLOR PARK DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8052
Practice Address - Country:US
Practice Address - Phone:614-863-0071
Practice Address - Fax:614-856-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5016261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHX20191Medicare UPIN