Provider Demographics
NPI:1336153196
Name:FAIR VISION INC
Entity Type:Organization
Organization Name:FAIR VISION INC
Other - Org Name:CARROLLTON FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-771-0148
Mailing Address - Street 1:113 N LISBON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1327
Mailing Address - Country:US
Mailing Address - Phone:330-627-2430
Mailing Address - Fax:330-627-5681
Practice Address - Street 1:113 N LISBON ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1327
Practice Address - Country:US
Practice Address - Phone:330-627-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561299Medicaid
OH0076271Medicaid
OH0171174Medicaid