Provider Demographics
NPI:1851502371
Name:VISION CLINICS GROUP LLC
Entity Type:Organization
Organization Name:VISION CLINICS GROUP LLC
Other - Org Name:WEST PARK VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KAMMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:216-941-3303
Mailing Address - Street 1:3760 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4050
Mailing Address - Country:US
Mailing Address - Phone:216-941-3303
Mailing Address - Fax:216-671-7447
Practice Address - Street 1:3760 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4050
Practice Address - Country:US
Practice Address - Phone:216-941-3303
Practice Address - Fax:216-671-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4466 T1122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366482Medicare PIN
OH6021480001Medicare NSC