MEDICARE: UNION VISION CENTER OF MANCHESTER RD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	OH 2089SC	OH
2	156FX1800X	Optician	2089-SC	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194778480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION VISION CENTER OF MANCHESTER RD, INC.

Provider Business Mailing Address
First Line	:	2355 MANCHESTER ROAD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-3639
Country	:	US
Telephone Number	:	330-753-2266
Fax Number	:	330-753-3320

Provider Business Practice Location Address
First Line	:	2355 MANCHESTER ROAD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-3639
Country	:	US
Telephone Number	:	330-753-2266
Fax Number	:	330-753-3320

Authorized Official
Title or Position	:	PRESIDENT AND COO
Name	:	PAMELA ANN FORSEA
Credential	:	L.D.O.
Telephone Number	:	330-753-2266

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	10/22/2012

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Directions to “UNION VISION CENTER OF MANCHESTER RD, INC. ” Practice Location

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