1114959137 NPI number — AKRON GENERAL'S VISION CENTER

Table of content: (NPI 1114959137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114959137 NPI number — AKRON GENERAL'S VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKRON GENERAL'S VISION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114959137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 715147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43271-5147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-344-3583
Provider Business Mailing Address Fax Number:
330-996-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
676 S BROADWAY ST
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44311-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-344-2020
Provider Business Practice Location Address Fax Number:
330-344-4111
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAILLARD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR FINANCE BUSINESS OPERATION
Authorized Official Telephone Number:
330-344-6095

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1750361416 . This is a "DR FLOWER INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: FL0424205 . This is a "DR FLOWER MEDICARE INDIVIDUAL NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com