1023721297 NPI number — EYE CARE ASSOCIATES, INC

Table of content: (NPI 1023721297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023721297 NPI number — EYE CARE ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE ASSOCIATES, 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:
1023721297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EYE CARE ASSOCIATES, INC.
Provider Second Line Business Mailing Address:
10 DUTTON DRIVE
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44502-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-884-6584
Provider Business Mailing Address Fax Number:
330-743-8368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EYE CARE ASSOCIATES, INC.
Provider Second Line Business Practice Location Address:
2670 S. RACCOON ROAD SUITE 1
Provider Business Practice Location Address City Name:
AUSTINTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44515-5380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-746-7691
Provider Business Practice Location Address Fax Number:
330-743-8368
Provider Enumeration Date:
01/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WOLSIEFER
Authorized Official First Name:
KAYLA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
330-884-6584

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9914991 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0010027 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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