MEDICARE: INNOVATIVE VISION LLC

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	5396	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4655840001	OTHER	OH	MEDICARE JURISDICTION B DME MAC

General Provider Information

NPI Number	:	1609037613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE VISION LLC

Provider Business Mailing Address
First Line	:	9711 MONTGOMERY RD
Second Line	:
City	:	MONTGOMERY
State	:	OH
Zip	:	45242-7207
Country	:	US
Telephone Number	:	513-793-8486
Fax Number	:	513-793-2023

Provider Business Practice Location Address
First Line	:	9711 MONTGOMERY RD
Second Line	:
City	:	MONTGOMERY
State	:	OH
Zip	:	45242-7207
Country	:	US
Telephone Number	:	513-793-8486
Fax Number	:	513-793-2023

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN K KUHLMAN
Credential	:	OD
Telephone Number	:	513-793-8486

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/05/2024

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