Healthcare Provider Details

I. General information

NPI: 1750832960
Provider Name (Legal Business Name): VISION PROFESSIONALS - SUNBURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 W CHERRY ST
SUNBURY OH
43074-8556
US

IV. Provider business mailing address

690 W CHERRY ST
SUNBURY OH
43074-8556
US

V. Phone/Fax

Practice location:
  • Phone: 740-965-4671
  • Fax:
Mailing address:
  • Phone: 740-965-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5241
License Number StateOH

VIII. Authorized Official

Name: DR. CHRIS A SMILEY
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 740-965-4671