NPIMap

Organization Active NPI

Vision Center LTD

  • Optometrist
  • Fairborn, OH
National Provider Identifier
1417034133
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VISION CENTER LTD
Practice address
1790 Commerce Center Blvd
Fairborn, OH 45324-6358
Phone
(937) 878-3941
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Authorized official

Name
Dr. Steven W ShroderNPI 1477605293
Title
Doctor
Phone
(937) 878-3941

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

1790 Commerce Center Blvd
Fairborn, OH 45324-6358

Mailing address

1790 Commerce Center Blvd
Fairborn, OH 45324-6358

Other identifiers 4

IdentifierTypeStateIssuer
2221956MedicaidOH
0887849MedicaidOH
0311200MedicaidOH
0898560MedicaidOH

Other names 1

  • The Fairborn Vision Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040707000909 OH Part B Supplier - Clinic/Group Practice 7214914282 Receives reassigned benefits from 3 practitioners
Practice locations: Fairborn, OH
O20100930034580 OH DME Supplier - Physician - OptometristDME Supplier - Optician 7214914282 Practice locations: Fairborn, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Vision Center1790 Commerce Center Blvd, Fairborn, OH 45324-6358(937) 878-3941 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Does not accept assignmentParticipating since Jan 1, 1995

National Provider Directory

National Provider Directory

Locations

1790 Commerce Center Blvd
Fairborn, OH 45324
Phone (937) 878-3941

Practitioners & affiliated clinicians

Practitioners 3

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1417034133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246358",
            "telephone_number": "937-878-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "SHRODER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "937-878-3941",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2221956",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0887849",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0311200",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0898560",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Fairborn Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairborn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.