Healthcare Provider Details

I. General information

NPI: 1255792453
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 NAVARRE AVE
OREGON OH
43616-3216
US

IV. Provider business mailing address

PO BOX 432
WABASH IN
46992-0432
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-4444
  • Fax: 419-697-2149
Mailing address:
  • Phone: 260-569-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY L GARNER
Title or Position: PRES/CEO
Credential:
Phone: 260-569-9550