Provider Demographics
NPI:1255599320
Name:MIAMI VALLEY VISION CARE, INC.
Entity type:Organization
Organization Name:MIAMI VALLEY VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-456-5559
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-0117
Mailing Address - Country:US
Mailing Address - Phone:937-456-5559
Mailing Address - Fax:937-456-1089
Practice Address - Street 1:309 EATON LEWISBURG RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1104
Practice Address - Country:US
Practice Address - Phone:937-456-5559
Practice Address - Fax:937-456-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0328425Medicaid
OH0328425Medicaid
OH0354480001Medicare NSC
OH0374961Medicare PIN