Provider Demographics
NPI:1710030242
Name:UNION VISION CENTER OF STOW, INC.
Entity Type:Organization
Organization Name:UNION VISION CENTER OF STOW, INC.
Other - Org Name:CO-OP OPTICAL EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-688-8244
Mailing Address - Street 1:3330 KENT RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4536
Mailing Address - Country:US
Mailing Address - Phone:330-688-8244
Mailing Address - Fax:
Practice Address - Street 1:3330 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4537
Practice Address - Country:US
Practice Address - Phone:330-688-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH77149067332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289263Medicaid
OH0289263Medicaid