Healthcare Provider Details

I. General information

NPI: 1528096203
Provider Name (Legal Business Name): OHIO VISION OF TOLEDO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 NAVARRE AVE
OREGON OH
43616-3216
US

IV. Provider business mailing address

2740 NAVARRE AVE
OREGON OH
43616-3216
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-4444
  • Fax: 419-697-2149
Mailing address:
  • Phone: 419-693-4444
  • Fax: 419-697-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM G. MARTIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 419-693-4444