Provider Demographics
NPI:1558989731
Name:WHEELERSBURG VISION CENTER LLC
Entity Type:Organization
Organization Name:WHEELERSBURG VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-2821
Mailing Address - Street 1:1915 SCIOTO TRL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2874
Mailing Address - Country:US
Mailing Address - Phone:740-354-2821
Mailing Address - Fax:740-354-6162
Practice Address - Street 1:536 BULWER ST
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1907
Practice Address - Country:US
Practice Address - Phone:740-354-2821
Practice Address - Fax:740-354-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty