Provider Demographics
NPI:1215098272
Name:PROCARE VISION CENTER OF CHILLICOTHE
Entity type:Organization
Organization Name:PROCARE VISION CENTER OF CHILLICOTHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOONGIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-773-8700
Mailing Address - Street 1:2530 WESTERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7527
Mailing Address - Country:US
Mailing Address - Phone:740-773-8700
Mailing Address - Fax:740-773-8701
Practice Address - Street 1:2530 WESTERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7527
Practice Address - Country:US
Practice Address - Phone:740-773-8700
Practice Address - Fax:740-773-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1215098272Medicare NSC
OHU18517Medicare UPIN
OH0460300002Medicare NSC