Provider Demographics
NPI:1831216605
Name:OPTI-VISION
Entity type:Organization
Organization Name:OPTI-VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-650-0919
Mailing Address - Street 1:5697 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4013
Mailing Address - Country:US
Mailing Address - Phone:330-650-0919
Mailing Address - Fax:330-656-3151
Practice Address - Street 1:5697 DARROW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4013
Practice Address - Country:US
Practice Address - Phone:330-650-0919
Practice Address - Fax:330-656-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC6292156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty