Provider Demographics
NPI:1457377814
Name:OHIO VISION OF TOLEDO,INC.
Entity Type:Organization
Organization Name:OHIO VISION OF TOLEDO,INC.
Other - Org Name:OPTIVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-639-4444
Mailing Address - Street 1:2740 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3216
Mailing Address - Country:US
Mailing Address - Phone:419-693-4444
Mailing Address - Fax:419-697-2149
Practice Address - Street 1:5733 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3006
Practice Address - Country:US
Practice Address - Phone:419-693-4444
Practice Address - Fax:419-697-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4585460002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673085Medicaid
OH4585460002Medicare NSC
OH9324733Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OHCK3185Medicare PIN