Healthcare Provider Details

I. General information

NPI: 1780887968
Provider Name (Legal Business Name): PRIMARY VISION CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 N 21ST ST
NEWARK OH
43055-2920
US

IV. Provider business mailing address

1625 ELMWOOD AVE
COLUMBUS OH
43212-2331
US

V. Phone/Fax

Practice location:
  • Phone: 740-366-7341
  • Fax: 740-366-5453
Mailing address:
  • Phone: 740-366-7341
  • Fax: 740-366-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number5612 T2526
License Number StateOH

VIII. Authorized Official

Name: DR. PHILIP N. ARNER
Title or Position: OPTOMETRISTS
Credential: O.D.
Phone: 740-366-7341