Healthcare Provider Details

I. General information

NPI: 1255756128
Provider Name (Legal Business Name): OHIO EYE OPTOMETRIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S WALNUT ST
BUCYRUS OH
44820-2325
US

IV. Provider business mailing address

466 S TRIMBLE RD SUITE D
MANSFIELD OH
44906-3416
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-8000
  • Fax: 419-756-7100
Mailing address:
  • Phone: 419-756-8000
  • Fax: 419-756-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number59900093
License Number StateOH

VIII. Authorized Official

Name: JONATHAN M SKARIE
Title or Position: OWNER
Credential: MD
Phone: 419-756-8000