Healthcare Provider Details

I. General information

NPI: 1649449745
Provider Name (Legal Business Name): AKRON VISION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W ROCHESTER ST
AKRON IN
46910-9997
US

IV. Provider business mailing address

PO BOX 640
AKRON IN
46910-0640
US

V. Phone/Fax

Practice location:
  • Phone: 574-893-7050
  • Fax:
Mailing address:
  • Phone: 574-893-7050
  • Fax: 574-893-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1800192A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number18001927A
License Number StateIN

VIII. Authorized Official

Name: MR. MARK S. HARRIS
Title or Position: OWNER/DOCTOR
Credential: OD
Phone: 574-893-7050