Provider Demographics
NPI:1558498733
Name:NEW DIRECTION OPTICAL
Entity Type:Organization
Organization Name:NEW DIRECTION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VIDMAR
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:330-422-1860
Mailing Address - Street 1:9288 MARKET SQUARE DR STE 18
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5208
Mailing Address - Country:US
Mailing Address - Phone:330-422-1860
Mailing Address - Fax:330-422-1861
Practice Address - Street 1:9288 MARKET SQUARE DR STE 18
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5208
Practice Address - Country:US
Practice Address - Phone:330-422-1860
Practice Address - Fax:330-422-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS6785156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherEIN NUMBER