Healthcare Provider Details

I. General information

NPI: 1578665717
Provider Name (Legal Business Name): OHIO EYECARE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/14/2011
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: 937-223-5416
Mailing address:
  • Phone: 937-222-3937
  • Fax: 937-223-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35-026034
License Number StateOH

VIII. Authorized Official

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