Healthcare Provider Details

I. General information

NPI: 1326189499
Provider Name (Legal Business Name): KUNESH EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FAR HILLS AVE
DAYTON OH
45419-1634
US

IV. Provider business mailing address

2601 FAR HILLS AVE
DAYTON OH
45419-1634
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-1093
  • Fax: 937-298-6344
Mailing address:
  • Phone: 937-298-1093
  • Fax: 937-298-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number106
License Number StateOH

VIII. Authorized Official

Name: MICHAEL T KUNESH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 937-298-1093