Provider Demographics
NPI:1255913190
Name:WEST MILTON VISION CENTER, LLC
Entity type:Organization
Organization Name:WEST MILTON VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STUCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-398-3886
Mailing Address - Street 1:21 N MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1831
Mailing Address - Country:US
Mailing Address - Phone:937-698-5171
Mailing Address - Fax:937-698-3600
Practice Address - Street 1:21 N MIAMI ST
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1831
Practice Address - Country:US
Practice Address - Phone:937-698-5171
Practice Address - Fax:937-698-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty