Provider Demographics
NPI:1700819455
Name:ROHOLT VISION INSTITUTE INC
Entity Type:Organization
Organization Name:ROHOLT VISION INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-305-2200
Mailing Address - Street 1:5890 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:N CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1547
Mailing Address - Country:US
Mailing Address - Phone:330-305-2200
Mailing Address - Fax:330-305-2210
Practice Address - Street 1:25 MANOR HILL DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1596
Practice Address - Country:US
Practice Address - Phone:330-702-8755
Practice Address - Fax:330-702-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH8515Medicare PIN