Organization
POWELL VISION CLINIC, LLC
Active
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
Update your record
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