Healthcare Provider Details

I. General information

NPI: 1699099291
Provider Name (Legal Business Name): MERCY EYE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 TALMADGE RD
TOLEDO OH
43623-3007
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-472-1113
  • Fax: 419-472-0618
Mailing address:
  • Phone: 419-251-2673
  • Fax: 419-251-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD M WARNER
Title or Position: REGIONAL CFO
Credential:
Phone: 419-251-2130