MEDICARE: HOMETOWN VISION CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	04039165	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	410001554	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60054	OTHER	OH	AETNA
2	285641915009	OTHER	OH	MEDICAL MUTUAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000282169	OTHER	OH	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1003975327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN VISION CENTER INC

Provider Business Mailing Address
First Line	:	6427 S MAIN ST
Second Line	:	P.O. BOX 509
City	:	NORTH KINGSVILLE
State	:	OH
Zip	:	44068-0509
Country	:	US
Telephone Number	:	440-224-2141
Fax Number	:	440-224-2436

Provider Business Practice Location Address
First Line	:	6427 S MAIN ST
Second Line	:
City	:	N KINGSVILLE
State	:	OH
Zip	:	44068-0509
Country	:	US
Telephone Number	:	440-224-2141
Fax Number	:	440-224-2436

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. RONALD ALAN WHEELER
Credential	:	O.D
Telephone Number	:	440-224-2141

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	11/20/2012

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Directions to “HOMETOWN VISION CENTER INC ” Practice Location

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