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	152W00000X	Optometrist	3548	OH

General Provider Information

NPI Number	:	1538342969
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	:	614-871-1300

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	:	614-871-1300

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOSEPH P LEISRING
Credential	:	O.D.
Telephone Number	:	614-871-2080

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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Directions to “OHIO VISION GROUP, INC ” Practice Location

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