Healthcare Provider Details

I. General information

NPI: 1366540726
Provider Name (Legal Business Name): OHIO LOW VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N UNION ST
LOUDONVILLE OH
44842-1074
US

IV. Provider business mailing address

631 N UNION ST
LOUDONVILLE OH
44842-1074
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 Code261Q00000X
TaxonomyClinic/Center
License Number4042
License Number StateOH

VIII. Authorized Official

Name: DR. JONATHAN JAY PFLUEGER
Title or Position: PRES.
Credential: O.D.
Phone: 419-994-3071