Provider Demographics
NPI:1184639841
Name:PRO-VISION INC
Entity type:Organization
Organization Name:PRO-VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BETTON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:419-625-6300
Mailing Address - Street 1:1206 HULL RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6061
Mailing Address - Country:US
Mailing Address - Phone:419-625-6300
Mailing Address - Fax:419-625-8901
Practice Address - Street 1:1206 HULL RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-6061
Practice Address - Country:US
Practice Address - Phone:419-625-6300
Practice Address - Fax:419-625-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3662-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820550001Medicare NSC