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NPI Code Detail

MEDICARE: OHIO VISION GROUP, INC.

MEDICARE: OHIO VISION GROUP, 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
1152W00000XOptometrist3548OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1410011217OTHEROHRAILROAD MEDICARE

General Provider Information

NPI Number : 1407024540
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO VISION GROUP, INC.
Provider Business Mailing Address
First Line : 3814 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2234
Country : US
Telephone Number : 614-871-2080
Fax Number : 614-871-1301
Provider Business Practice Location Address
First Line : 3814 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2234
Country : US
Telephone Number : 614-871-2080
Fax Number : 614-871-1301
Authorized Official
Title or Position : VICE PRESIDENT
Name : DR. JOSEPH P. LEISRING
Credential : O.D.
Telephone Number : 614-871-2080
Provider Enumeration Date : 02/12/2008
Last Update Date : 10/06/2009

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Directions to “OHIO VISION GROUP, INC. ” Practice Location

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