Glandorf Vision Group Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2916 Issued in OH

Legal business name

GLANDORF VISION GROUP INC.

Practice address

102 Dr Thatye Drive
Glandorf, OH 45848-0020

Phone

(419) 538-6273

Fax

(419) 538-7273

NPI assigned

Jan 25, 2007

Last updated

Jul 14, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adria Petrick

Title

Office Manager

Phone

(419) 538-6273

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abigail Hilvers, OD

  • Optometrist
  • Glandorf, OH
  • NPI 1679468417
  Medicare reassignment Care Compare group NPD
• Jesselyn Elizabeth Michaud, O.D.

  • Optometrist
  • Glandorf, OH
  • NPI 1437531050
  Medicare reassignment Care Compare group NPD
• Lindsey Kremer, OD

  • Optometrist
  • Lima, OH
  • NPI 1396115606
  Medicare reassignment NPD

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1457406696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20",
            "city": "GLANDORF",
            "state": "OH",
            "postal_code": "458480020",
            "telephone_number": "419-538-6273",
            "fax_number": "419-538-7273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 DR THATYE DRIVE",
            "city": "GLANDORF",
            "state": "OH",
            "postal_code": "458480020",
            "telephone_number": "419-538-6273",
            "fax_number": "419-538-7273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLANDORF VISION GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "PETRICK",
        "authorized_official_first_name": "ADRIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "419-538-6273"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "2916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410037333",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0179266",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "30140272400",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000140764",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Glandorf, OH
• Providers in Glandorf, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.