Healthcare Provider Details

I. General information

NPI: 1770152332
Provider Name (Legal Business Name): MY VISION MIDDLEFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 S SPRINGDALE AVE UNIT 6
MIDDLEFIELD OH
44062-7226
US

IV. Provider business mailing address

1 MEMORY LN STE 200
GARRETTSVILLE OH
44231-9443
US

V. Phone/Fax

Practice location:
  • Phone: 330-527-4852
  • Fax:
Mailing address:
  • Phone: 330-527-4852
  • Fax: 330-527-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN KILGORE
Title or Position: BILLING MANAGER
Credential:
Phone: 330-527-4852