Provider Demographics
NPI:1679862957
Name:CAPITAL VISION CARE, INC.
Entity Type:Organization
Organization Name:CAPITAL VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCSURDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-457-2081
Mailing Address - Street 1:2066 W. HENDERSON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2452
Mailing Address - Country:US
Mailing Address - Phone:614-457-2081
Mailing Address - Fax:614-457-6021
Practice Address - Street 1:2066 W. HENDERSON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2452
Practice Address - Country:US
Practice Address - Phone:614-457-2081
Practice Address - Fax:614-457-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4215152W00000X, 152WC0802X, 152WP0200X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH097583Medicaid
OH097583Medicaid