Provider Demographics
NPI:1649449745
Name:AKRON VISION CENTER PC
Entity type:Organization
Organization Name:AKRON VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-893-7050
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:IN
Mailing Address - Zip Code:46910-0640
Mailing Address - Country:US
Mailing Address - Phone:574-893-7050
Mailing Address - Fax:574-893-7540
Practice Address - Street 1:100 W ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IN
Practice Address - Zip Code:46910-9997
Practice Address - Country:US
Practice Address - Phone:574-893-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001927A332H00000X
IN1800192A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000246844OtherBLUE CROSS BLUE SHIELD
000000246844OtherBLUE CROSS BLUE SHIELD
T86616Medicare UPIN
270600Medicare PIN