=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558498733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DIRECTION OPTICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9288 MARKET SQUARE DR STE 18
-----------------------------------------------------
City | STREETSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44241-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-422-1860
-----------------------------------------------------
Fax | 330-422-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9288 MARKET SQUARE DR STE 18
-----------------------------------------------------
City | STREETSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44241-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-422-1860
-----------------------------------------------------
Fax | 330-422-1861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CONNIE JEAN VIDMAR
-----------------------------------------------------
Credential | ABOC
-----------------------------------------------------
Telephone | 330-422-1860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | S6785
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------