Provider Demographics
NPI:1790935484
Name:MARY E REX
Entity Type:Organization
Organization Name:MARY E REX
Other - Org Name:CALDWELL VISION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:REX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-732-4620
Mailing Address - Street 1:402 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-1234
Mailing Address - Country:US
Mailing Address - Phone:740-732-4620
Mailing Address - Fax:740-732-7179
Practice Address - Street 1:402 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1234
Practice Address - Country:US
Practice Address - Phone:740-732-4620
Practice Address - Fax:740-732-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3891SC156FX1800X, 335E00000X
3891SC332B00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0735404Medicaid
OH0735404Medicaid
OH0873390001Medicare UPIN
OH0873390001Medicare NSC