Provider Demographics
NPI:1417034133
Name:VISION CENTER LTD
Entity Type:Organization
Organization Name:VISION CENTER LTD
Other - Org Name:THE FAIRBORN VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-878-3941
Mailing Address - Street 1:1790 COMMERCE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1790 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6358
Practice Address - Country:US
Practice Address - Phone:937-878-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221956Medicaid
OH0887849Medicaid
OH0311200Medicaid
OH0898560Medicaid
OHU76106Medicare UPIN
OH0887849Medicaid
OHU33771Medicare UPIN
OHU82019Medicare UPIN
OH0898560Medicaid