Provider Demographics
NPI:1265187769
Name:MY VISION CENTERS LLC
Entity type:Organization
Organization Name:MY VISION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-527-4852
Mailing Address - Street 1:1 MEMORY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9443
Mailing Address - Country:US
Mailing Address - Phone:330-527-3937
Mailing Address - Fax:
Practice Address - Street 1:570 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2144
Practice Address - Country:US
Practice Address - Phone:330-743-9816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY VISION CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty