Provider Demographics
NPI:1528096203
Name:OHIO VISION OF TOLEDO INC
Entity type:Organization
Organization Name:OHIO VISION OF TOLEDO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-693-4444
Mailing Address - Street 1:2740 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3216
Mailing Address - Country:US
Mailing Address - Phone:419-693-4444
Mailing Address - Fax:419-697-2149
Practice Address - Street 1:2740 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3216
Practice Address - Country:US
Practice Address - Phone:419-693-4444
Practice Address - Fax:419-697-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673085Medicaid
OH2190657OtherUNITED HEALTH CARE
OH4559068OtherAETNA
OH4559068OtherAETNA
OH2190657OtherUNITED HEALTH CARE
OH9324733Medicare PIN
OHCK3185Medicare PIN
OH9324734Medicare PIN
OH2673085Medicaid