1477075562 NPI number — PROFESSIONAL VISION CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477075562 NPI number — PROFESSIONAL VISION CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL VISION CARE
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:
1477075562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
937 POLARIS WOODS BLVD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-8076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-898-5285
Provider Business Mailing Address Fax Number:
614-898-3054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 GRAPHICS WAY
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
LEWIS CENTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-898-9989
Provider Business Practice Location Address Fax Number:
614-898-3054
Provider Enumeration Date:
07/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
COLOGGI
Authorized Official First Name:
KYLA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-898-9989

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)





Copyright © 2007-2025 www.npivalidator.com