Active NPI
Professional Vision Inc
- Optometrist
- South Bend, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18001393
- Legal business name
- PROFESSIONAL VISION INC
- Practice address
- 17615 State Road 23
South Bend, IN 46635-1718 - Phone
- (574) 234-7600
- Fax
- (574) 234-8408
- NPI assigned
- Sep 28, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ronald L Snyder, OD
- Title
- Owner-President
- Phone
- (574) 234-7600
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001393 | IN | Primary |
Addresses
Primary practice location
17615 State Road 23
South Bend, IN 46635-1718
Mailing address
17615 State Road 23
South Bend, IN 46635-1718
Phone (574) 234-7600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000105030 | Other | IN | ANTHEM |
National Provider Directory
National Provider Directory- Tax ID family
- Professional Vision Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- South Bend, IN
- NPI 1700971686
Locations
17615 State Road 23
South Bend, IN 46635
Phone (574) 234-7600
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Optometrist
- South Bend, IN
- NPI 1740258441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1912098229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17615 STATE ROAD 23",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351718",
"telephone_number": "574-234-7600",
"fax_number": "574-234-8408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17615 STATE ROAD 23",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351718",
"telephone_number": "574-234-7600",
"fax_number": "574-234-8408"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROFESSIONAL VISION INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-28",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SNYDER",
"authorized_official_first_name": "RONALD",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER-PRESIDENT",
"authorized_official_telephone_number": "574-234-7600",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18001393",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000105030",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.