Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 MANCHESTER ROAD
AKRON OH
44314-3639
US

IV. Provider business mailing address

2355 MANCHESTER ROAD
AKRON OH
44314-3639
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-2266
  • Fax: 330-753-3320
Mailing address:
  • Phone: 330-753-2266
  • Fax: 330-753-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2089-SC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOH 2089SC
License Number StateOH

VIII. Authorized Official

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