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General NPI Number Information
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NPI Number | 1386601193
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Entity Type | Organization
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Legal Business Name | EYE SURGEON ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1490 PINEHURST DR
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City | DEFIANCE
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State | OH
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Zip | 43512-8670
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Country | US
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Telephone | 419-782-6588
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Fax | 419-784-3622
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Provider Business Mailing Address
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Address Line | 1490 PINEHURST DR
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City | DEFIANCE
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State | OH
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Zip | 43512-8670
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Country | US
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Telephone | 419-782-6588
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Fax | 419-784-3622
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PHILIP H. O'DONNELL
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Credential | M.D.
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Telephone | 419-782-6588
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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 | 35063310
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License Number State | OH
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