Provider Demographics
NPI:1205985900
Name:COLE VISION CORPORATION
Entity type:Organization
Organization Name:COLE VISION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:2215 MEMORIAL DR
Mailing Address - Street 2:HATCHER POINT MALL
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-0983
Mailing Address - Country:US
Mailing Address - Phone:912-283-1619
Mailing Address - Fax:912-283-1630
Practice Address - Street 1:2215 MEMORIAL DR
Practice Address - Street 2:HATCHER POINT MALL
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-0983
Practice Address - Country:US
Practice Address - Phone:912-283-1619
Practice Address - Fax:912-283-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0507951415Medicare ID - Type Unspecified