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General NPI Number Information
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NPI Number | 1003975327
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Entity Type | Organization
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Legal Business Name | HOMETOWN VISION CENTER INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 6427 S MAIN ST
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City | N KINGSVILLE
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State | OH
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Zip | 44068-0509
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Country | US
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Telephone | 440-224-2141
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Fax | 440-224-2436
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Provider Business Mailing Address
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Address Line | 6427 S MAIN ST P.O. BOX 509
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City | NORTH KINGSVILLE
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State | OH
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Zip | 44068-0509
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Country | US
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Telephone | 440-224-2141
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Fax | 440-224-2436
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RONALD ALAN WHEELER
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Credential | O.D
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Telephone | 440-224-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 04039165
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License Number State | OH
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