MEDICARE: OH EYE ASSOCIATES 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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	00004564419	OTHER	AETNA
2	00122022	OTHER	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0800600	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1174790679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OH EYE ASSOCIATES INC

Provider Business Mailing Address
First Line	:	8110 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6243
Country	:	US
Telephone Number	:	330-758-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	16761 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-382-0573
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KIMBERLY MAE HORNE
Credential	:
Telephone Number	:	330-758-0900

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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Directions to “OH EYE ASSOCIATES INC ” Practice Location

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