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General NPI Number Information
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NPI Number | 1730204694
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL VISIONCARE LLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 185 S STATE ST
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City | WESTERVILLE
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State | OH
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Zip | 43081-2232
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Country | US
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Telephone | 614-898-9989
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Fax | 614-898-3054
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Provider Business Mailing Address
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Address Line | 185 S STATE ST
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City | WESTERVILLE
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State | OH
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Zip | 43081-2232
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Country | US
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Telephone | 614-898-9989
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Fax | 614-898-3054
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRADLEY J JOHNSON
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Credential | O.D.
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Telephone | 614-898-9989
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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 |
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License Number State |
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