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Organization

POWELL VISION CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BLAKE G. POWELL O.D. (OWNER)
(419) 698-4949
Entity
Organization

Contact information

Practice address
3975 NAVARRE AVE, OREGON, OH 43616-3437
(419) 698-4949
(419) 698-9948
Mailing address
3975 NAVARRE AVE, OREGON, OH 43616-3437
(419) 698-4949
(419) 698-9948

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
332H00000X
Eyewear Supplier

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0418613
OH
Enumeration date
04/03/2008
Last updated
09/29/2016
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