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General NPI Number Information
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NPI Number | 1083917819
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Entity Type | Organization
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Legal Business Name | PROCARE VISION CENTER, LLC
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 316 2ND ST
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City | MARIETTA
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State | OH
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Zip | 45750-2919
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Country | US
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Telephone | 740-374-3937
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Fax | 740-376-9437
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Provider Business Mailing Address
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Address Line | 316 2ND ST
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City | MARIETTA
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State | OH
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Zip | 45750-2919
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Country | US
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Telephone | 740-374-3937
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Fax | 740-376-9437
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. HOLLY LARAINE SPROUT
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Credential | O.D.
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Telephone | 740-374-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5542
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License Number State | OH
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