NPIMap

Organization Active NPI

Dr Patrick Henry OD LLC

Doing business as Lifetime Vision Care Center

  • Vision Therapy Optometrist
  • Maumee, OH
National Provider Identifier
1659401180
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vision Therapy OptometristTaxonomy code 152WV0400X
License
5163 T2062 Issued in OH
Legal business name
DR PATRICK HENRY OD LLC
Doing business as
Lifetime Vision Care Center
Practice address
109 West Wayne St
Maumee, OH 43537-2150
Phone
(419) 893-6841
Fax
(419) 893-4894
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Mrs. Hope D Wcislak
Title
Billing Manager
Phone
(419) 893-6841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WV0400X 5163 T2062 OH Primary

Addresses

Primary practice location

109 West Wayne St
Maumee, OH 43537-2150

Mailing address

109 West Wayne St
Maumee, OH 43537-2150
Phone (419) 893-6841

Other identifiers 2

IdentifierTypeStateIssuer
5163 T2062OtherOHSTATE LICENSE NUMBER
2196672MedicaidOH

Other names 1

  • LIFETIME VISION CARE CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

109 W Wayne St
Maumee, OH 43537
Phone (419) 893-6841

5860 Lewis Ave
Toledo, OH 43612
Phone (419) 476-4511

Practitioners & affiliated clinicians

Practitioners 2

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1659401180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WEST WAYNE ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372150",
            "telephone_number": "419-893-6841",
            "fax_number": "419-893-4894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WEST WAYNE ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372150",
            "telephone_number": "419-893-6841",
            "fax_number": "419-893-4894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR PATRICK HENRY OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "WCISLAK",
        "authorized_official_first_name": "HOPE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "419-893-6841",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "OH",
            "license": "5163 T2062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "5163 T2062",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2196672",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFETIME VISION CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.