Organization
GLANDORF VISION GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIA PETRICK (OFFICE MANAGER)
(419) 538-6273
Entity
Organization
Contact information
Practice address
102 DR THATYE DRIVE, GLANDORF, OH 45848-0020
(419) 538-6273
(419) 538-7273
Mailing address
PO BOX 20, GLANDORF, OH 45848-0020
(419) 538-6273
(419) 538-7273
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2916
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000140764
ANTHEM BCBS
OH
05
—
0179266
—
OH
01
—
30140272400
BWC
OH
01
—
410037333
RAILROAD MEDICARE
OH
Enumeration date
01/25/2007
Last updated
07/14/2021
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