Healthcare Provider Details

I. General information

NPI: 1407866601
Provider Name (Legal Business Name): OHIO VISION GROUP INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 W MOUND ST
COLUMBUS OH
43223-1907
US

IV. Provider business mailing address

1454 W MOUND ST
COLUMBUS OH
43223-1907
US

V. Phone/Fax

Practice location:
  • Phone: 614-276-5441
  • Fax: 614-276-1700
Mailing address:
  • Phone: 614-276-5441
  • Fax: 614-276-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2908/T455
License Number StateOH

VIII. Authorized Official

Name: LAWRENCE GILL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 614-276-5441