MEDICARE: EYE CENTERS OF OHIO, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1114964657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTERS OF OHIO, INC

Provider Business Mailing Address
First Line	:	730 MCKINLEY AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-3404
Country	:	US
Telephone Number	:	330-458-3000
Fax Number	:	330-458-3006

Provider Business Practice Location Address
First Line	:	800 MCKINLEY AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-2463
Country	:	US
Telephone Number	:	330-452-8884
Fax Number	:	330-452-2404

Authorized Official
Title or Position	:	CEO
Name	:	JOHN MALIK
Credential	:
Telephone Number	:	330-966-1111

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/25/2010

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