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General NPI Number Information
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NPI Number | 1366218687
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Entity Type | Organization
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Legal Business Name | NORTHEAST OHIO EYE SURGEONS, INC.
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 915 LINCOLN WAY E
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City | MASSILLON
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State | OH
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Zip | 44646-6833
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Country | US
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Telephone | 330-833-1091
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Fax | 330-833-1092
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Provider Business Mailing Address
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Address Line | 915 LINCOLN WAY E
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City | MASSILLON
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State | OH
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Zip | 44646-6833
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Country | US
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Telephone | 330-833-1091
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Fax | 330-833-1092
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MARGARITA TACEY
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Credential |
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Telephone | 616-893-9794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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