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General NPI Number Information
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NPI Number | 1285807685
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO EYE SURGICAL ASSOC., LLC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1456 JACKSON PIKE SUITE 2
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City | GALLIPOLIS
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State | OH
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Zip | 45631-2602
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Country | US
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Telephone | 740-446-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 159 E 2ND ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2526
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Country | US
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Telephone | 740-773-6347
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN DEMICK
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Credential |
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Telephone | 740-773-6347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 27012133
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License Number State | OH
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