NPIMap

Organization Active NPI

Primary Vision Care of Mount Vernon Inc

  • Optometrist
  • Wilmington, OH
National Provider Identifier
1720633209
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PRIMARY VISION CARE OF MOUNT VERNON INC
Practice address
2079 Rombach Ave
Wilmington, OH 45177-1996
Phone
(937) 382-4933
NPI assigned
Aug 2, 2019
Last updated
Aug 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Authorized official

Name
Mark David HenryNPI 1275527467
Title
Owner
Phone
(740) 654-9909

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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

2079 Rombach Ave
Wilmington, OH 45177-1996

Mailing address

2079 Rombach Ave
Wilmington, OH 45177-1996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181126002980 OH Part B Supplier - Clinic/Group Practice 1850645102 Receives reassigned benefits from 7 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, OH; Waynesville, OH; Wilmington, OH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Primary Vision Care3 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.

Locations

1684 Venture Dr
Ste A
Mount Vernon, OH 43050
Phone (740) 393-6010

2079 Rombach Ave
Wilmington, OH 45177
Phone (937) 382-4933

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1720633209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 ROMBACH AVE",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451771996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2079 ROMBACH AVE",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451771996",
            "telephone_number": "937-382-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY VISION CARE OF MOUNT VERNON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-654-9909"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; 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.