Provider Demographics
NPI:1922472430
Name:OPTICARE VISION CENTERS, LLC
Entity Type:Organization
Organization Name:OPTICARE VISION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-544-3325
Mailing Address - Street 1:125 S MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1220
Mailing Address - Country:US
Mailing Address - Phone:937-544-3325
Mailing Address - Fax:937-382-6644
Practice Address - Street 1:125 S MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1220
Practice Address - Country:US
Practice Address - Phone:937-544-3325
Practice Address - Fax:937-382-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty