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General NPI Number Information
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NPI Number | 1013641703
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Entity Type | Organization
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Legal Business Name | LEBANON VISION CENTER, LLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 777 COLUMBUS AVE
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City | LEBANON
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State | OH
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Zip | 45036-1684
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Country | US
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Telephone | 513-932-3343
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Fax | 216-365-6403
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Provider Business Mailing Address
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Address Line | 777 COLUMBUS AVE
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City | LEBANON
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State | OH
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Zip | 45036-1684
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Country | US
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Telephone | 513-932-3343
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Fax | 216-365-6403
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JENNIE HUBER
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Credential |
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Telephone | 513-398-3886
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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 |
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License Number State |
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