Provider Demographics
NPI:1407024540
Name:OHIO VISION GROUP, INC.
Entity type:Organization
Organization Name:OHIO VISION GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEISRING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-871-2080
Mailing Address - Street 1:3814 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2234
Mailing Address - Country:US
Mailing Address - Phone:614-871-2080
Mailing Address - Fax:614-871-1301
Practice Address - Street 1:3814 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2234
Practice Address - Country:US
Practice Address - Phone:614-871-2080
Practice Address - Fax:614-871-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO VISION GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH410011217OtherRAILROAD MEDICARE
OH410011217OtherRAILROAD MEDICARE
OH9253512Medicare PIN
OHT47300Medicare PIN