Healthcare Provider Details

I. General information

NPI: 1568581965
Provider Name (Legal Business Name): OHIO EYE CARE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3583 RESERVE COMMONS DR
MEDINA OH
44256-8180
US

IV. Provider business mailing address

3583 RESERVE COMMONS DR
MEDINA OH
44256-8180
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-8300
  • Fax: 330-725-0445
Mailing address:
  • Phone: 330-722-8300
  • Fax: 330-725-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNA L PERRIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 330-722-8300