MEDICARE: THE EYE CLINIC 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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689937229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EYE CLINIC INC

Provider Business Mailing Address
First Line	:	3545 LINCOLN WAY E
Second Line	:	SUITE A
City	:	MASSILLON
State	:	OH
Zip	:	44646-8624
Country	:	US
Telephone Number	:	330-837-5191
Fax Number	:	330-837-0755

Provider Business Practice Location Address
First Line	:	1605 PORTAGE RD NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720
Country	:	US
Telephone Number	:	330-433-1350
Fax Number	:	330-305-5021

Authorized Official
Title or Position	:	PRESIDENT CORPORATION
Name	:	DR. BRIAN E WIND
Credential	:	D.O,
Telephone Number	:	330-837-5191

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	09/09/2014

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Directions to “THE EYE CLINIC INC ” Practice Location

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