1841460482 NPI number — DAYTON OPTOMETRIC CENTER INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841460482 NPI number — DAYTON OPTOMETRIC CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYTON OPTOMETRIC CENTER 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:
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:
1841460482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SOUTHMOOR CIR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-293-8685
Provider Business Mailing Address Fax Number:
937-293-2337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 WILMINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45419-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-293-8685
Provider Business Practice Location Address Fax Number:
937-293-2337
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
HEATH
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
937-293-8685

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0141626 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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