MEDICARE: VISIONARY OPTOMETRY 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	2835/T598	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386646701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY OPTOMETRY INC

Provider Business Mailing Address
First Line	:	10551 W NATIONAL RD
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-9299
Country	:	US
Telephone Number	:	937-845-9444
Fax Number	:	937-845-8511

Provider Business Practice Location Address
First Line	:	10551 W NATIONAL RD
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-9299
Country	:	US
Telephone Number	:	937-845-9444
Fax Number	:	937-845-8511

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NOELLE K GEHM
Credential	:	OD
Telephone Number	:	937-845-9444

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/29/2020

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Directions to “VISIONARY OPTOMETRY INC ” Practice Location

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