1154871119 NPI number — LOHMAN EYE CARE ASSOCIATES

Table of content: (NPI 1154871119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154871119 NPI number — LOHMAN EYE CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOHMAN EYE CARE ASSOCIATES
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:
6
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:
1154871119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 SANDY LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAVENNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44266-8208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-688-8811
Provider Business Mailing Address Fax Number:
330-688-9550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 KENT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-688-8811
Provider Business Practice Location Address Fax Number:
330-688-9550
Provider Enumeration Date:
10/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOHMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
330-688-8811

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3133 , 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: 2275396 OH , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 298421012 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".