Provider Demographics
NPI:1811132582
Name:POWELL VISION CENTER, INC
Entity type:Organization
Organization Name:POWELL VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-336-3727
Mailing Address - Street 1:3998 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7662
Mailing Address - Country:US
Mailing Address - Phone:614-336-3727
Mailing Address - Fax:614-336-9958
Practice Address - Street 1:3998 POWELL RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7662
Practice Address - Country:US
Practice Address - Phone:614-336-3727
Practice Address - Fax:614-336-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4391152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9394361Medicare PIN