Provider Demographics
NPI:1053817478
Name:SPRINGBORO VISION, LLC
Entity type:Organization
Organization Name:SPRINGBORO VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-398-3886
Mailing Address - Street 1:245 N MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9171
Mailing Address - Country:US
Mailing Address - Phone:937-748-2955
Mailing Address - Fax:937-748-3193
Practice Address - Street 1:245 N MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9171
Practice Address - Country:US
Practice Address - Phone:937-748-2955
Practice Address - Fax:937-748-3193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASON VISION CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty