Provider Demographics
NPI:1710179254
Name:CADIZ VISION CENTER, LTD
Entity Type:Organization
Organization Name:CADIZ VISION CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-942-4433
Mailing Address - Street 1:143 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1106
Mailing Address - Country:US
Mailing Address - Phone:740-942-4433
Mailing Address - Fax:740-942-3897
Practice Address - Street 1:143 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1106
Practice Address - Country:US
Practice Address - Phone:740-942-4433
Practice Address - Fax:740-942-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4771152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU65730Medicare UPIN
OH9338301Medicare PIN
OH5082800001Medicare NSC