Healthcare Provider Details

I. General information

NPI: 1205871621
Provider Name (Legal Business Name): ROHOLT VISION INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4228
US

IV. Provider business mailing address

5890 MAYFAIR RD
CANTON OH
44720-1547
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-6410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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