=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649449745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AKRON VISION CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2008
-----------------------------------------------------
Last Update Date | 01/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W ROCHESTER ST
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46910-9997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-893-7050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 640
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46910-0640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-893-7050
-----------------------------------------------------
Fax | 574-893-7540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | MR. MARK S. HARRIS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 574-893-7050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 18001927A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 1800192A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------