Looking Glass Eyecare Professionals LLC
Organization Active NPI Optometrist · Loudonville, OH
NPI 1881839983 · NPPES record last updated Dec 4, 2008
Key facts
- NPI
- 1881839983
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 5806 (OH)
- Legal business name
- LOOKING GLASS EYECARE PROFESSIONALS LLC
- Practice address
- 631 N Union St
Loudonville, OH 44842-1074 - Phone
- (419) 994-3071
- Fax
- (419) 994-4422
- NPI assigned
- Dec 4, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Jennifer Lynn Miller, O.D.
- Title
- Owner/Optometrist
- Phone
- (419) 994-3071
Corporate family (same tax ID) 1
Practitioners 1
-
Jennifer Lynn Smith, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090706000019 | OH | Part B Supplier - Clinic/Group Practice | 4880745082 |
Receives reassigned benefits from 1 practitioner Practice locations: Loudonville, OH; Wooster, OH |
National Provider Directory
- Tax ID family
- Looking Glass Eyecare Professionals
Locations
1651 Beall Ave
Wooster, OH 44691
Phone (330) 345-8076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 5806 | OH | Yes |
Addresses
Primary practice location
631 N Union St
Loudonville, OH 44842-1074
Mailing address
631 N Union St
Loudonville, OH 44842-1074
Phone (419) 994-3071
Other names
- Loudonville Family Vision
Other providers in Loudonville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.