PROFESSIONAL VISION INC NPI 1700971686

Optometrist in South Bend, IN

About PROFESSIONAL VISION INC

Professional Vision Inc is a provider in South Bend, IN. The NPI number assigned to this provider is 1700971686. The practitioner's primary taxonomy code is Optometrist (152W00000X). The provider is registered as an organization and their NPI record was last updated 11 years ago. Professional Vision Inc operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI

1700971686

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NamePROFESSIONAL VISION INC
Provider Location Address4630 W WESTERN AVE SOUTH BEND, IN 46619 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address17615 STATE ROAD 23 SOUTH BEND, IN 46635 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-04-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date07-08-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

PROFESSIONAL VISION INC
4630 W WESTERN AVE
SOUTH BEND, IN
ZIP 46619
Phone: (574) 287-5949
Fax: (574) 287-6068
Get Directions

Mailing Address

PROFESSIONAL VISION INC
17615 STATE ROAD 23
SOUTH BEND, IN
ZIP 46635
Phone: (574) 234-7600
Fax: (574) 234-8408

Primary Taxonomy

Taxonomy Code152W00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationOptometrist
TypeEye and Vision Services Providers
License No.18001393
License StateIN
Taxonomy DescriptionDoctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Authorized Official

Authorized Official NameDR. RONALD L SNYDER OD Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleOWNER-PRESIDENT
Authorized Official Phone(574) 234-7600

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
198990MEDICARE ID-TYPE UNSPECIFIED (04)IN
000000105031OTHER (01)IN

Map Location


PROFESSIONAL VISION INC address is 4630 W WESTERN AVE SOUTH BEND, IN 46619
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