MEDICARE: ADVANCED EYE CARE SURGERY CENTER LLC

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	261QS0132X	Ophthalmologic Surgery Clinic/Center	0796AS	OH

General Provider Information

NPI Number	:	1750312534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EYE CARE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1991 PARK AVENUE WEST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906
Country	:	US
Telephone Number	:	419-521-3937
Fax Number	:	419-522-5189

Provider Business Practice Location Address
First Line	:	1991 PARK AVENUE WEST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906
Country	:	US
Telephone Number	:	419-521-3937
Fax Number	:	419-522-5189

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HAROLD A BALLITCH II
Credential	:	M.D.
Telephone Number	:	419-512-2927

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/02/2024

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