Provider Demographics
NPI:1902089766
Name:PRACTICE OF OPTOMETRY, INC
Entity Type:Organization
Organization Name:PRACTICE OF OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WYLIE
Authorized Official - Last Name:BINNS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-353-2020
Mailing Address - Street 1:2808 SCIOTO TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2244
Mailing Address - Country:US
Mailing Address - Phone:740-353-2020
Mailing Address - Fax:740-353-2020
Practice Address - Street 1:2808 SCIOTO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2244
Practice Address - Country:US
Practice Address - Phone:740-353-2020
Practice Address - Fax:740-353-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3845T768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102414Medicaid
OH410046798OtherRAILROAD MEDICARE
OH410046798OtherRAILROAD MEDICARE
OHU61212Medicare UPIN
OH2102414Medicaid