Provider Demographics
NPI:1215087374
Name:COLE VISION CORPORATION
Entity type:Organization
Organization Name:COLE VISION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:561 BELT LINE RD
Mailing Address - Street 2:THE LAKESIDE PLAZA
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4411
Mailing Address - Country:US
Mailing Address - Phone:618-345-6663
Mailing Address - Fax:618-345-7047
Practice Address - Street 1:561 BELT LINE RD
Practice Address - Street 2:THE LAKESIDE PLAZA
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4411
Practice Address - Country:US
Practice Address - Phone:618-345-6663
Practice Address - Fax:618-345-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0507951102Medicare UPIN