MEDICARE: MIAMISBURG VISION CARE

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912111436	OTHER	OH	NPI 1912111436

General Provider Information

NPI Number	:	1912111436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMISBURG VISION CARE

Provider Business Mailing Address
First Line	:	340 ALEXANDERSVILLE ROAD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-2554
Country	:	US
Telephone Number	:	937-866-3471
Fax Number	:	937-866-5242

Provider Business Practice Location Address
First Line	:	340 ALEXANDERSVILLE ROAD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-2554
Country	:	US
Telephone Number	:	937-866-3471
Fax Number	:	937-866-5242

Authorized Official
Title or Position	:	MEMBER, LLC
Name	:	DR. KEITH BASINGER
Credential	:	O.D.
Telephone Number	:	937-866-3471

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	05/24/2013

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Directions to “MIAMISBURG VISION CARE ” Practice Location

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