Provider Demographics
NPI:1609088459
Name:PORTSMOUTH VISION CENTER, LTD
Entity Type:Organization
Organization Name:PORTSMOUTH VISION CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-354-2821
Mailing Address - Street 1:1915 SCIOTO TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-354-2821
Mailing Address - Fax:740-354-6162
Practice Address - Street 1:1915 SCIOTO TRAIL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
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:2007-05-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCG0703Medicare PIN
1283590001Medicare NSC
OHPO9308471Medicare PIN