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General NPI Number Information
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NPI Number | 1124136189
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Entity Type | Organization
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Legal Business Name | THE EYE CLINIC, INC.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 3545 LINCOLN WAY E SUITE A
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City | MASSILLON
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State | OH
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Zip | 44646-8624
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Country | US
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Telephone | 330-837-5191
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Fax | 330-837-0755
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Provider Business Mailing Address
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Address Line | 3545 LINCOLN WAY E SUITE A
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City | MASSILLON
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State | OH
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Zip | 44646-8624
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Country | US
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Telephone | 330-837-5191
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Fax | 330-837-0755
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL G WOOD
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Credential | DO
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Telephone | 330-837-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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