Provider Demographics
NPI:1386646701
Name:VISIONARY OPTOMETRY INC
Entity Type:Organization
Organization Name:VISIONARY OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GEHM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-845-9444
Mailing Address - Street 1:10551 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9299
Mailing Address - Country:US
Mailing Address - Phone:937-845-9444
Mailing Address - Fax:937-845-8511
Practice Address - Street 1:10551 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-9299
Practice Address - Country:US
Practice Address - Phone:937-845-9444
Practice Address - Fax:937-845-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2835/T598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2046100Medicaid
OHT46190Medicare UPIN
OH1236100001Medicare NSC
OH9298881Medicare ID - Type Unspecified
OH2046100Medicaid