Healthcare Provider Details

I. General information

NPI: 1760868525
Provider Name (Legal Business Name): ZANESVILLE VISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 E MAIN ST
MCCONNELSVILLE OH
43756-1180
US

IV. Provider business mailing address

71 E MAIN ST
MCCONNELSVILLE OH
43756-1180
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-4281
  • Fax: 740-962-5741
Mailing address:
  • Phone: 740-962-4281
  • Fax: 740-962-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY R BELLVILLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-453-1611