Healthcare Provider Details

I. General information

NPI: 1245315068
Provider Name (Legal Business Name): EYE CARE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 N RIVER RD NE
WARREN OH
44484-1039
US

IV. Provider business mailing address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7691
  • Fax: 330-743-8368
Mailing address:
  • Phone: 330-884-6584
  • Fax: 330-743-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAYLA R WOLSIEFER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 330-884-6584