Provider Demographics
NPI:1477075562
Name:PROFESSIONAL VISION CARE
Entity Type:Organization
Organization Name:PROFESSIONAL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLOGGI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-898-9989
Mailing Address - Street 1:937 POLARIS WOODS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8076
Mailing Address - Country:US
Mailing Address - Phone:614-898-5285
Mailing Address - Fax:614-898-3054
Practice Address - Street 1:7100 GRAPHICS WAY
Practice Address - Street 2:SUITE 3200
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035
Practice Address - Country:US
Practice Address - Phone:614-898-9989
Practice Address - Fax:614-898-3054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL VISION CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty