Provider Demographics
NPI:1639336068
Name:BLEVINS & BLEVINS, INC.
Entity Type:Organization
Organization Name:BLEVINS & BLEVINS, INC.
Other - Org Name:LOUISVILLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-875-2300
Mailing Address - Street 1:503 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1421
Mailing Address - Country:US
Mailing Address - Phone:330-875-2300
Mailing Address - Fax:330-875-4110
Practice Address - Street 1:503 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1421
Practice Address - Country:US
Practice Address - Phone:330-875-2300
Practice Address - Fax:330-875-4110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLEVINS & BLEVINS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH410046640OtherRAILROAD MEDICARE
OH0561315Medicaid
OH0561315Medicaid
OH0693600002Medicare NSC
OH410046640OtherRAILROAD MEDICARE