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General NPI Number Information
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NPI Number | 1285968362
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Entity Type | Organization
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Legal Business Name | HARBOURTOWN VISION INC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 5491 LIBERTY AVE
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City | VERMILION
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State | OH
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Zip | 44089-1307
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Country | US
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Telephone | 440-967-2020
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Fax | 440-967-3228
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Provider Business Mailing Address
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Address Line | 5491 LIBERTY AVE
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City | VERMILION
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State | OH
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Zip | 44089-1307
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Country | US
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Telephone | 440-967-2020
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Fax | 440-967-3228
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES LANCE WIGHT
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Credential | O.D
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Telephone | 440-967-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2775
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License Number State | OH
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