NPIMap

Organization Active NPI

Primesource Healthcare of Ohio, Inc.

  • Optometrist
  • Columbus, OH
National Provider Identifier
1255506713
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PRIMESOURCE HEALTHCARE OF OHIO, INC.
Practice address
4449 Easton Way
Floor 2
Columbus, OH 43219-6093
Phone
(800) 317-0711
Fax
(847) 267-9440
NPI assigned
Apr 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

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

Authorized official

Name
Mr. David Fleming
Title
President & Ceo
Phone
(847) 267-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4449 Easton Way
Floor 2
Columbus, OH 43219-6093

Mailing address

2100 East Lake Cook Road
Suite 1100
Buffalo Grove, IL 60089-1815
Phone (847) 267-8200

Other identifiers 1

IdentifierTypeStateIssuer
2758350MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Primesource Healthcare of Ohio Inc3 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.

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1255506713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 EAST LAKE COOK ROAD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891815",
            "telephone_number": "847-267-8200",
            "fax_number": "877-821-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4449 EASTON WAY",
            "address_2": "FLOOR 2",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432196093",
            "telephone_number": "800-317-0711",
            "fax_number": "847-267-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMESOURCE HEALTHCARE OF OHIO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "847-267-8200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2758350",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.