Basic Information
| Provider Information | |||||||||
| NPI: | 1679506984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISIONONE PROFESSIONAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432214314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144871022 | ||||||||
| FaxNumber: | 6144871030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432214314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144871022 | ||||||||
| FaxNumber: | 6144871030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEALS | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | NICHOLS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6144871022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4221 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.