1235285628 NPI number — DAYTON EYE SURGERY CENTER L L C

Table of content: (NPI 1235285628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235285628 NPI number — DAYTON EYE SURGERY CENTER L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYTON EYE SURGERY CENTER L L C
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:
1235285628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 SYLVANIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45440-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-431-9531
Provider Business Mailing Address Fax Number:
937-431-9532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 SYLVANIA DR
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:
45440-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-431-9531
Provider Business Practice Location Address Fax Number:
937-431-9532
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEISENBURGH
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
DON/ADMINISTRATOR
Authorized Official Telephone Number:
937-431-9531

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0553AS , 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: 490004334 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6800130 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2138449 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64394 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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