NPIMap

Organization Active NPI

Primary Vision Care of Mount Vernon Inc

  • Optometrist
  • Mount Vernon, OH
National Provider Identifier
1801329180
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4713 Issued in OH
Legal business name
PRIMARY VISION CARE OF MOUNT VERNON INC
Practice address
1684 Venture Dr
Ste a
Mount Vernon, OH 43050-8950
Phone
(740) 393-6010
Fax
(740) 393-2320
NPI assigned
Apr 4, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Authorized official

Name
Dr. Mark D. Henry, O.D.NPI 1275527467
Title
President/Owner
Phone
(740) 366-7341

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 4713 OH Primary

Addresses

Primary practice location

1684 Venture Dr
Ste a
Mount Vernon, OH 43050-8950

Mailing address

926 N 21St St
Newark, OH 43055-2920
Phone (740) 366-7341

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
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

Practitioners & affiliated clinicians

Practitioners 7

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": "1491264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1801329180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 N 21ST ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552920",
            "telephone_number": "740-366-7341",
            "fax_number": "740-366-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 VENTURE DR",
            "address_2": "STE A",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430508950",
            "telephone_number": "740-393-6010",
            "fax_number": "740-393-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY VISION CARE OF MOUNT VERNON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-04",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "740-366-7341",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.