Healthcare Provider Details

I. General information

NPI: 1053342238
Provider Name (Legal Business Name): OHIO VISION OF TOLEDO,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
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: 419-639-4444
  • Fax: 419-697-2149
Mailing address:
  • Phone: 419-639-4444
  • Fax: 419-697-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number0066AS
License Number StateOH

VIII. Authorized Official

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