Healthcare Provider Details

I. General information

NPI: 1679862957
Provider Name (Legal Business Name): CAPITAL VISION CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 W. HENDERSON RD SUITE 104
COLUMBUS OH
43220-2452
US

IV. Provider business mailing address

2066 W. HENDERSON RD SUITE 104
COLUMBUS OH
43220-2452
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-2081
  • Fax: 614-457-6021
Mailing address:
  • Phone: 614-457-2081
  • Fax: 614-457-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4215
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4215
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4215
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number4215
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4215
License Number StateOH

VIII. Authorized Official

Name: DR. CRAIG C. MCSURDY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 614-457-2081