Provider Demographics
NPI:1760638167
Name:COLUMBUS VISION ASSOCIATES, INC
Entity Type:Organization
Organization Name:COLUMBUS VISION ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-431-2099
Mailing Address - Street 1:487 LAZELLE RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9540
Mailing Address - Country:US
Mailing Address - Phone:614-431-2099
Mailing Address - Fax:614-431-2011
Practice Address - Street 1:487 LAZELLE RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9540
Practice Address - Country:US
Practice Address - Phone:614-431-2099
Practice Address - Fax:614-431-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1255270001Medicare NSC
OH0796254Medicare PIN