Provider Demographics
NPI:1295860559
Name:GUNNING AMES PTRS
Entity Type:Organization
Organization Name:GUNNING AMES PTRS
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GUNNING
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:740-947-2945
Mailing Address - Street 1:218 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1148
Mailing Address - Country:US
Mailing Address - Phone:740-947-2945
Mailing Address - Fax:740-947-1458
Practice Address - Street 1:218 E NORTH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1148
Practice Address - Country:US
Practice Address - Phone:740-947-2945
Practice Address - Fax:740-947-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029370Medicaid
21023OtherCVC
U27624Medicare UPIN
0394510002Medicare ID - Type Unspecified
CC0225Medicare ID - Type Unspecified
T45967Medicare UPIN
OH2029370Medicaid