MEDICARE: INTRINSIC VISION LLC

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

General Provider Information

NPI Number	:	1194542209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRINSIC VISION LLC

Provider Business Mailing Address
First Line	:	850 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	440-361-4180
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN O'BRIEN
Credential	:	OD
Telephone Number	:	440-834-2119

Provider Enumeration Date	:	09/21/2024
Last Update Date	:	09/21/2024

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Directions to “INTRINSIC VISION LLC ” Practice Location

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