Provider Demographics
NPI:1932552924
Name:OHIO HEARING & VISION PROFESSIONALS, LLC
Entity type:Organization
Organization Name:OHIO HEARING & VISION PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:ACA, BC-HIS, ABOC
Authorized Official - Phone:419-443-0710
Mailing Address - Street 1:1500 S. COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:419-443-0710
Mailing Address - Fax:419-443-0576
Practice Address - Street 1:421 A E. WALTON ST.
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890
Practice Address - Country:US
Practice Address - Phone:419-933-4327
Practice Address - Fax:419-933-4336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO HEARING PROFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2823237700000X, 332S00000X
OH2891T2834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3086002Medicaid