Provider Demographics
NPI:1245550987
Name:CADIZ VISION CENTER LTD
Entity type:Organization
Organization Name:CADIZ VISION CENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-343-6941
Mailing Address - Street 1:515 N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2862
Mailing Address - Country:US
Mailing Address - Phone:330-343-6941
Mailing Address - Fax:330-343-5941
Practice Address - Street 1:515 N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2862
Practice Address - Country:US
Practice Address - Phone:330-343-6941
Practice Address - Fax:330-343-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU65730Medicare UPIN
OH5082800002Medicare NSC