Provider Demographics
NPI:1518177492
Name:VISION CLINICS GROUP LLC
Entity Type:Organization
Organization Name:VISION CLINICS GROUP LLC
Other - Org Name:MIDDLEBURG HEIGHTS VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KAMMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:440-843-6900
Mailing Address - Street 1:7199 PEARL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4947
Mailing Address - Country:US
Mailing Address - Phone:440-843-6900
Mailing Address - Fax:440-886-7238
Practice Address - Street 1:7199 PEARL RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4947
Practice Address - Country:US
Practice Address - Phone:440-843-6900
Practice Address - Fax:440-886-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4466 T1122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366481Medicare PIN
OH6021480002Medicare NSC