Provider Demographics
NPI:1326541863
Name:OPTICARE VISION CENTERS, LLC
Entity Type:Organization
Organization Name:OPTICARE VISION CENTERS, LLC
Other - Org Name:OPTICARE VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-409-4900
Mailing Address - Street 1:2220 GRANDVIEW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1691
Mailing Address - Country:US
Mailing Address - Phone:859-578-0393
Mailing Address - Fax:859-815-8896
Practice Address - Street 1:2220 GRANDVIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1691
Practice Address - Country:US
Practice Address - Phone:859-578-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty