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General NPI Number Information
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NPI Number | 1013185271
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Entity Type | Organization
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Legal Business Name | PROCARE VISION ENTER
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 1155 COLUMBUS PIKE
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City | DELAWARE
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State | OH
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Zip | 43015-2713
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Country | US
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Telephone | 740-363-0787
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Fax | 740-363-2927
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Provider Business Mailing Address
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Address Line | 1155 COLUMBUS PIKE
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City | DELAWARE
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State | OH
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Zip | 43015-2713
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Country | US
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Telephone | 740-363-0787
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Fax | 740-363-2927
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS D.D. OTT
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Credential |
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Telephone | 740-363-0787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3848
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License Number State | OH
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