Healthcare Provider Details

I. General information

NPI: 1750335154
Provider Name (Legal Business Name): EYE INSTITUTE OF NORTHWESTERN OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 BRIARFIELD BLVD
MAUMEE OH
43537-9383
US

IV. Provider business mailing address

3509 BRIARFIELD BLVD
MAUMEE OH
43537-9383
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-3866
  • Fax: 419-865-3451
Mailing address:
  • Phone: 419-865-3866
  • Fax: 419-865-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number0003AS
License Number StateOH

VIII. Authorized Official

Name: MRS. SHARON E DUCHIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-865-3866