NPIMap

Organization Active NPI

Primary Vision Care of Mount Vernon Inc

  • Optometrist
  • Waynesville, OH
National Provider Identifier
1194340943
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PRIMARY VISION CARE OF MOUNT VERNON INC
Practice address
4353 E State Route 73
Waynesville, OH 45068-8812
Phone
(513) 897-2211
Fax
(513) 897-2213
NPI assigned
Jun 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark David HenryNPI 1275527467
Title
Owner
Phone
(740) 654-9909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4353 E State Route 73
Waynesville, OH 45068-8812

Mailing address

4353 E State Route 73
Waynesville, OH 45068-8812
Phone (513) 897-2211

Other names 1

  • Primary Vision Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181126002980 OH Part B Supplier - Clinic/Group Practice 1850645102 Receives reassigned benefits from 7 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, OH; Waynesville, OH; Wilmington, OH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Primary Vision Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1194340943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4353 E STATE ROUTE 73",
            "city": "WAYNESVILLE",
            "state": "OH",
            "postal_code": "450688812",
            "telephone_number": "513-897-2211",
            "fax_number": "513-897-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4353 E STATE ROUTE 73",
            "city": "WAYNESVILLE",
            "state": "OH",
            "postal_code": "450688812",
            "telephone_number": "513-897-2211",
            "fax_number": "513-897-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY VISION CARE OF MOUNT VERNON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-654-9909"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waynesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.