Provider Demographics
NPI:1801946025
Name:COLE VISION CORPROATION
Entity type:Organization
Organization Name:COLE VISION CORPROATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:4640 S MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2556
Mailing Address - Country:US
Mailing Address - Phone:574-231-0726
Mailing Address - Fax:574-231-0808
Practice Address - Street 1:4640 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2556
Practice Address - Country:US
Practice Address - Phone:574-231-0726
Practice Address - Fax:574-231-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0507951689Medicare ID - Type Unspecified