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General NPI Number Information
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NPI Number | 1336153196
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Entity Type | Organization
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Legal Business Name | FAIR VISION INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 113 N LISBON ST
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City | CARROLLTON
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State | OH
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Zip | 44615-1327
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Country | US
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Telephone | 330-627-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 113 N LISBON ST
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City | CARROLLTON
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State | OH
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Zip | 44615-1327
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Country | US
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Telephone | 330-627-2430
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Fax | 330-627-5681
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELSEA D NAYLOR
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Credential | OD
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Telephone | 330-771-0148
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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 | 3728
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License Number State | OH
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