Healthcare Provider Details

I. General information

NPI: 1366218687
Provider Name (Legal Business Name): NORTHEAST OHIO EYE SURGEONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 LINCOLN WAY E
MASSILLON OH
44646-6833
US

IV. Provider business mailing address

915 LINCOLN WAY E
MASSILLON OH
44646-6833
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-1091
  • Fax: 330-833-1092
Mailing address:
  • Phone: 330-833-1091
  • Fax: 330-833-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARITA TACEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 616-893-9794