NPIMap

Organization Active NPI

Vision Source Marysville

  • Optometrist
  • Marysville, OH
National Provider Identifier
1992316848
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VISION SOURCE MARYSVILLE
Practice address
303 W 5TH St
Marysville, OH 43040-1113
Phone
(937) 644-2075
NPI assigned
Aug 13, 2020
Last updated
May 10, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COURTNEY L POLING ODAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Authorized official

Name
Mrs. Mallorie Goodridge
Title
Office Manager
Phone
(937) 644-8637

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

303 W 5TH St
Marysville, OH 43040-1113

Mailing address

303 W 5TH St
Marysville, OH 43040-1113

Other names 1

  • Courtney Lynn Poling OD Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210520002732 OH Part B Supplier - Clinic/Group Practice 6800295064 Receives reassigned benefits from 3 practitioners
Practice locations: Marysville, OH

National Provider Directory

National Provider Directory
Part of
Courtney L Poling OD

Locations

1001 W 5th St
Marysville, OH 43040
Phone (937) 644-8637

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1992316848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W 5TH ST",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 W 5TH ST",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401113",
            "telephone_number": "937-644-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE MARYSVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COURTNEY L POLING OD",
        "enumeration_date": "2020-08-13",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "GOODRIDGE",
        "authorized_official_first_name": "MALLORIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "937-644-8637",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courtney Lynn Poling OD",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Courtney Lynn Poling OD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Marysville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.