Provider Demographics
NPI:1194984310
Name:VISION CENTER OF LIMA, LLC
Entity type:Organization
Organization Name:VISION CENTER OF LIMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-228-9176
Mailing Address - Street 1:1593 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2205
Mailing Address - Country:US
Mailing Address - Phone:419-228-9176
Mailing Address - Fax:419-228-5935
Practice Address - Street 1:1593 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2205
Practice Address - Country:US
Practice Address - Phone:419-228-9176
Practice Address - Fax:419-228-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 3334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH 0410755Medicaid
OH5170570001Medicare NSC