Provider Demographics
NPI:1194778480
Name:UNION VISION CENTER OF MANCHESTER RD, INC.
Entity type:Organization
Organization Name:UNION VISION CENTER OF MANCHESTER RD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FORSEA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:330-753-2266
Mailing Address - Street 1:2355 MANCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3639
Mailing Address - Country:US
Mailing Address - Phone:330-753-2266
Mailing Address - Fax:330-753-3320
Practice Address - Street 1:2355 MANCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3639
Practice Address - Country:US
Practice Address - Phone:330-753-2266
Practice Address - Fax:330-753-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2089-SC156FX1800X
OHOH 2089SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289254Medicaid
OH0289254Medicaid
OHOTH000Medicare UPIN
OH0592020001Medicare NSC