Provider Demographics
NPI:1912111436
Name:MIAMISBURG VISION CARE
Entity Type:Organization
Organization Name:MIAMISBURG VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-866-3471
Mailing Address - Street 1:340 ALEXANDERSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-2554
Mailing Address - Country:US
Mailing Address - Phone:937-866-3471
Mailing Address - Fax:937-866-5242
Practice Address - Street 1:340 ALEXANDERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2554
Practice Address - Country:US
Practice Address - Phone:937-866-3471
Practice Address - Fax:937-866-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1912111436OtherNPI 1912111436
OH9351781Medicare PIN
OH1912111436OtherNPI 1912111436