Provider Demographics
NPI:1366490559
Name:KENTON VISION CARE, INC.
Entity Type:Organization
Organization Name:KENTON VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-673-0492
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-0635
Mailing Address - Country:US
Mailing Address - Phone:419-673-0492
Mailing Address - Fax:
Practice Address - Street 1:110 N HIGH ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1549
Practice Address - Country:US
Practice Address - Phone:419-673-0492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA8949OtherRAILROAD MEDICARE
OHKE9336091Medicare PIN
OHDA8949OtherRAILROAD MEDICARE