=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770666844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9088 SUPERIOR AVE
-----------------------------------------------------
City | STREETSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44241-5699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-626-2029
-----------------------------------------------------
Fax | 330-626-5955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2555
-----------------------------------------------------
City | STREETSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44241-0555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-626-2029
-----------------------------------------------------
Fax | 330-626-5955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SAMUEL ROBERT COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-626-2029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 888
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------