1932351681 NPI number — PLAZA OPTOMETRISTS INC.

Table of content: (NPI 1932351681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932351681 NPI number — PLAZA OPTOMETRISTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAZA OPTOMETRISTS 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:
1932351681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 W FEDERAL ST
Provider Second Line Business Mailing Address:
SUITE T 4
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44503-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-638-4097
Provider Business Mailing Address Fax Number:
330-637-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3018 STATE ROUTE 5
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44410-9178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-638-4097
Provider Business Practice Location Address Fax Number:
330-637-0140
Provider Enumeration Date:
10/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-638-4097

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3343 T420 , 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: NUMBERS PENDING . This is a "NUMBERS PENDING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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