Provider Demographics
NPI:1720290208
Name:MOBILE AMERICA VISIONCARE, INC.
Entity Type:Organization
Organization Name:MOBILE AMERICA VISIONCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-314-7042
Mailing Address - Street 1:570 N. STATE STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7135
Mailing Address - Country:US
Mailing Address - Phone:614-596-3183
Mailing Address - Fax:614-259-6554
Practice Address - Street 1:570 N. STATE STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7135
Practice Address - Country:US
Practice Address - Phone:614-596-3183
Practice Address - Fax:614-259-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0784549Medicaid
OH0784549Medicaid