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
1	152WC0802X	Corneal and Contact Management Optometrist	2908/T455	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410011215	OTHER	OH	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1407866601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO VISION GROUP INC,

Provider Business Mailing Address
First Line	:	1454 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1907
Country	:	US
Telephone Number	:	614-276-5441
Fax Number	:	614-276-1700

Provider Business Practice Location Address
First Line	:	1454 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1907
Country	:	US
Telephone Number	:	614-276-5441
Fax Number	:	614-276-1700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE GILL
Credential	:	O.D.
Telephone Number	:	614-276-5441

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	11/11/2008

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