=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689886418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINCHESTER VISION CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 05/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6472 WINCHESTER BLVD
-----------------------------------------------------
City | CANAL WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43110-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-837-9595
-----------------------------------------------------
Fax | 614-837-8205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6472 WINCHESTER BLVD
-----------------------------------------------------
City | CANAL WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43110-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-837-9595
-----------------------------------------------------
Fax | 614-837-8205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | STEVEN T MANNING
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 614-837-9595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------