Provider Demographics
NPI:1326022054
Name:PROCARE VISION CENTERS INC
Entity Type:Organization
Organization Name:PROCARE VISION CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:MELVILLE
Authorized Official - Last Name:BICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-587-3937
Mailing Address - Street 1:1955 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9170
Mailing Address - Country:US
Mailing Address - Phone:740-587-3937
Mailing Address - Fax:740-587-3589
Practice Address - Street 1:1955 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9170
Practice Address - Country:US
Practice Address - Phone:740-587-3937
Practice Address - Fax:740-587-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581857Medicaid
OH4544500001Medicare NSC
OH9325131Medicare PIN
OHDA6386Medicare PIN
OH0581857Medicaid