MEDICARE: NEW DIRECTION OPTICAL

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	156FX1800X	Optician	S6785	OH

General Provider Information

NPI Number	:	1558498733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DIRECTION OPTICAL

Provider Business Mailing Address
First Line	:	9288 MARKET SQUARE DR STE 18
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5208
Country	:	US
Telephone Number	:	330-422-1860
Fax Number	:	330-422-1861

Provider Business Practice Location Address
First Line	:	9288 MARKET SQUARE DR STE 18
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5208
Country	:	US
Telephone Number	:	330-422-1860
Fax Number	:	330-422-1861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CONNIE JEAN VIDMAR
Credential	:	ABOC
Telephone Number	:	330-422-1860

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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Directions to “NEW DIRECTION OPTICAL ” Practice Location

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