1255419966 NPI number — THOMAS H. HANDEL OD, INC.

Table of content: (NPI 1255419966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255419966 NPI number — THOMAS H. HANDEL OD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS H. HANDEL OD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HANDEL VISION CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255419966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 S CLEVELAND MASSILLON RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-666-1766
Provider Business Mailing Address Fax Number:
330-670-9662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 S CLEVELAND MASSILLON RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-666-1766
Provider Business Practice Location Address Fax Number:
330-670-9662
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANDEL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
HEINZ
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-666-1766

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3945/T474 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000387842 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DP4279 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 256763 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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