Healthcare Provider Details

I. General information

NPI: 1487127163
Provider Name (Legal Business Name): VISION PROFESSIONALS DELAWARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTHWOOD DR
DELAWARE OH
43015-1501
US

IV. Provider business mailing address

730 MOUNT AIRYSHIRE BLVD
COLUMBUS OH
43235-1364
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-7701
  • Fax:
Mailing address:
  • Phone: 614-832-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS SMILEY
Title or Position: OWNER
Credential:
Phone: 614-832-2020