Healthcare Provider Details

I. General information

NPI: 1588609978
Provider Name (Legal Business Name): ROHOLT VISION INSTITITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 W STATE ST
ALLIANCE OH
44601-4686
US

IV. Provider business mailing address

5890 MAYFAIR RD
CANTON OH
44720-1547
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-2311
  • Fax:
Mailing address:
  • Phone: 330-305-2200
  • Fax: 330-305-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE BONTRAGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-305-2200