Healthcare Provider Details

I. General information

NPI: 1003942434
Provider Name (Legal Business Name): SAMUEL A. SEBASTIAN & GENE HRYCAK DBA OPTICAL VISION OF YOUNGSTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 CANFIELD RD SUITE #1
YOUNGSTOWN OH
44511-2800
US

IV. Provider business mailing address

2959 CANFIELD RD SUITE #1
YOUNGSTOWN OH
44511-2800
US

V. Phone/Fax

Practice location:
  • Phone: 330-792-7045
  • Fax: 330-792-0038
Mailing address:
  • Phone: 330-792-7045
  • Fax: 330-792-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberSC 198
License Number StateOH

VIII. Authorized Official

Name: MR. SAMUEL A SEBASTIAN
Title or Position: PARTNER
Credential: OPTICIAN
Phone: 330-792-7045