Powell Vision Clinic, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

POWELL VISION CLINIC, LLC

Practice address

3975 Navarre Ave
Oregon, OH 43616-3437

Phone

(419) 698-4949

Fax

(419) 698-9948

NPI assigned

Apr 3, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Blake G. Powell, O.D.

Title

Owner

Phone

(419) 698-4949

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1710150347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3975 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163437",
            "telephone_number": "419-698-4949",
            "fax_number": "419-698-9948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163437",
            "telephone_number": "419-698-4949",
            "fax_number": "419-698-9948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWELL VISION CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-03",
        "last_updated": "2016-09-29",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-698-4949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0418613",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole M. Polce
• Kathleen C Pollauf, LMT
• Adrienne Pontius, PA-C
• Shameka Poole, RN
• Antonio Porter
• Powell Vision Clinic, LLC
• Blake Gordon Powell, O.D.
• Kim Gordon Powell, O.D.
• Lynette Sue Powell, O.D.
• Mary Frances Powers, R.PH., PH.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.