Healthcare Provider Details

I. General information

NPI: 1558464636
Provider Name (Legal Business Name): THE EYE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 AMHERST RD NE SUITE 204
MASSILLON OH
44646-8518
US

IV. Provider business mailing address

3545 LINCOLN WAY E STE A
MASSILLON OH
44646-8624
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-6812
  • Fax: 330-837-0755
Mailing address:
  • Phone: 330-837-5191
  • Fax: 330-837-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN E WIND
Title or Position: PRESIDENT
Credential: D.O.
Phone: 330-837-5191