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General NPI Number Information
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NPI Number | 1457406696
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Entity Type | Organization
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Legal Business Name | GLANDORF VISION GROUP INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 102 DR THATYE DRIVE
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City | GLANDORF
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State | OH
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Zip | 45848-0020
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Country | US
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Telephone | 419-538-6273
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Fax | 419-538-7273
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Provider Business Mailing Address
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Address Line | PO BOX 20
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City | GLANDORF
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State | OH
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Zip | 45848-0020
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Country | US
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Telephone | 419-538-6273
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Fax | 419-538-7273
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ADRIA PETRICK
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Credential |
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Telephone | 419-538-6273
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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 | 2916
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License Number State | OH
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