1508983768 NPI number — SSK OPTOMETRY, LTD.

Table of content: (NPI 1508983768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508983768 NPI number — SSK OPTOMETRY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSK OPTOMETRY, LTD.
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:
Provider Other Organization Name Type Code:
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:
1508983768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2656 AMBERWICK PL
Provider Second Line Business Mailing Address:
SAMANTHA KINROSS O.D.
Provider Business Mailing Address City Name:
HILLIARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43026-8894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-893-4820
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5123 TUTTLE CROSSING BLVD
Provider Second Line Business Practice Location Address:
SAMANTHA KINROSS O.D.
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-734-1570
Provider Business Practice Location Address Fax Number:
614-734-1566
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KINROSS
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-893-4820

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4877 T1742 , 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)