Basic Information
| Provider Information | |||||||||
| NPI: | 1194843847 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL VISION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 HILLIARD ROME OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430267287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147771111 | ||||||||
| FaxNumber: | 6147777920 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 HILLIARD ROME OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430267287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147771111 | ||||||||
| FaxNumber: | 6147777920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | PIPO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 6147771111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.