Provider Demographics
NPI:1922025402
Name:VANCE, TRISHA BARNES (OD)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:BARNES
Last Name:VANCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:602 SOUTH ST
Mailing Address - Street 2:SUITE B-14
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1499
Mailing Address - Country:US
Mailing Address - Phone:440-285-5007
Mailing Address - Fax:440-285-4313
Practice Address - Street 1:602 SOUTH ST
Practice Address - Street 2:SUITE B-14
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1499
Practice Address - Country:US
Practice Address - Phone:440-285-5007
Practice Address - Fax:440-285-4313
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4169691OtherPIN
V06649Medicare UPIN