Healthcare Provider Details

I. General information

NPI: 1346263563
Provider Name (Legal Business Name): LOUDONVILLE FAMILY VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N UNION ST
LOUDONVILLE OH
44842
US

IV. Provider business mailing address

631 N UNION ST
LOUDONVILLE OH
44842
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-3071
  • Fax: 419-994-4422
Mailing address:
  • Phone: 419-994-3071
  • Fax: 419-994-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN J PFLUEGER
Title or Position: PRES
Credential: OD
Phone: 419-994-3071