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General NPI Number Information
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NPI Number | 1801281852
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Entity Type | Organization
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Legal Business Name | OHIO EYE OPTOMETRIC, LLC
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 76 W MAIN ST
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City | SHELBY
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State | OH
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Zip | 44875-1206
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Country | US
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Telephone | 419-756-8000
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Fax | 419-756-2601
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Provider Business Mailing Address
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Address Line | 466 S TRIMBLE RD
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City | MANSFIELD
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State | OH
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Zip | 44906-3416
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Country | US
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Telephone | 419-756-8000
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Fax | 419-756-2601
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN M SKARIE
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Credential | MD
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Telephone | 419-756-8000
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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 | 70048219
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License Number State | OH
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