Provider Demographics
NPI:1770644593
Name:JEFFREY W COLLINS OD INC
Entity Type:Organization
Organization Name:JEFFREY W COLLINS OD INC
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-523-6339
Mailing Address - Street 1:127 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1548
Mailing Address - Country:US
Mailing Address - Phone:513-523-6339
Mailing Address - Fax:513-523-6330
Practice Address - Street 1:127 LYNN AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1548
Practice Address - Country:US
Practice Address - Phone:513-523-6339
Practice Address - Fax:513-523-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9292452Medicare ID - Type UnspecifiedMC-OX GROUP #