Provider Demographics
NPI:1407866601
Name:OHIO VISION GROUP INC,
Entity type:Organization
Organization Name:OHIO VISION GROUP INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-276-5441
Mailing Address - Street 1:1454 W MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1907
Mailing Address - Country:US
Mailing Address - Phone:614-276-5441
Mailing Address - Fax:614-276-1700
Practice Address - Street 1:1454 W MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1907
Practice Address - Country:US
Practice Address - Phone:614-276-5441
Practice Address - Fax:614-276-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2908/T455152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH410011215OtherRAILROAD MEDICARE
OH9253511Medicare PIN
OH0560960001Medicare NSC
OH410011215OtherRAILROAD MEDICARE