Organization
POWELL VISION CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE GORDON POWELL O.D. (OWNER/OPTOMETRIST)
(419) 698-4949
Entity
Organization
Contact information
Practice address
3975 NAVARRE AVE, OREGON, OH 43616-3437
(419) 698-4949
Mailing address
3975 NAVARRE AVE, OREGON, OH 43616-3437
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6309/T3225
OH
Other
Enumeration date
01/18/2017
Last updated
03/28/2017
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