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General NPI Number Information
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NPI Number | 1902933294
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Entity Type | Organization
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Legal Business Name | PROCARE VISION CENTER
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 343 W BAGLEY RD SUITE 106
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City | BEREA
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State | OH
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Zip | 44017-1370
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Country | US
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Telephone | 440-891-1940
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Fax | 440-891-9028
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Provider Business Mailing Address
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Address Line | 343 W BAGLEY RD SUITE 106
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City | BEREA
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State | OH
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Zip | 44017-1370
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Country | US
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Telephone | 440-891-1940
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Fax | 440-891-9028
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Authorized Official
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Title or Position | OWNER
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Name | JAMES A RUMP
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Credential | L.D.O.
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Telephone | 440-891-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 403SC
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License Number State | OH
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