Provider Demographics
NPI:1700060050
Name:ENVISION EYECARE LLC
Entity Type:Organization
Organization Name:ENVISION EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-562-0057
Mailing Address - Street 1:236 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2221
Mailing Address - Country:US
Mailing Address - Phone:419-562-0057
Mailing Address - Fax:419-562-0073
Practice Address - Street 1:236 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2221
Practice Address - Country:US
Practice Address - Phone:419-562-0057
Practice Address - Fax:419-562-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5307152W00000X
OH6421770001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU92240Medicare UPIN