Healthcare Provider Details

I. General information

NPI: 1346105723
Provider Name (Legal Business Name): PHB VISION GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3972 W JEFFERSON BLVD
FORT WAYNE IN
46804-6812
US

IV. Provider business mailing address

1622 COMMONS DR
GENEVA IL
60134-2531
US

V. Phone/Fax

Practice location:
  • Phone: 260-434-1998
  • Fax:
Mailing address:
  • Phone: 630-335-3043
  • Fax: 630-225-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL H BASTERMAJIAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 630-335-3043