Healthcare Provider Details

I. General information

NPI: 1255508321
Provider Name (Legal Business Name): OHIO EYECARE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SUGAR CAMP CIR STE 200
DAYTON OH
45409-1962
US

IV. Provider business mailing address

105 SUGAR CAMP CIR STE 200
DAYTON OH
45409-1962
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-3937
  • Fax: 937-496-3595
Mailing address:
  • Phone: 937-222-3937
  • Fax: 937-496-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4207-S
License Number StateOH

VIII. Authorized Official

Name: MRS. KAREN S JOHNSON
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 937-853-2854