MEDICARE: NORTHEAST OHIO EYE SURGEONS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669123329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO EYE SURGEONS INC

Provider Business Mailing Address
First Line	:	2013 STATE ROUTE 59
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-4113
Country	:	US
Telephone Number	:	330-678-0201
Fax Number	:	330-678-4272

Provider Business Practice Location Address
First Line	:	6407 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7263
Country	:	US
Telephone Number	:	330-996-1111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE E LOHMAN
Credential	:	MD
Telephone Number	:	330-678-0201

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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