1306926068 NPI number — DR. RUSSELL A MARINGER OD

Table of content: DR. RUSSELL A MARINGER OD (NPI 1306926068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306926068 NPI number — DR. RUSSELL A MARINGER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARINGER
Provider First Name:
RUSSELL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1306926068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3972 S MEMORIAL SHOREWAY DR
Provider Second Line Business Mailing Address:
EYE SURGERY CONSULTANTS INC.
Provider Business Mailing Address City Name:
LAKESIDE MARBLEHEAD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43440-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-230-0263
Provider Business Mailing Address Fax Number:
866-651-8467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 W WATER ST STE L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HARBOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43449-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-898-1918
Provider Business Practice Location Address Fax Number:
866-651-8467
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  5494/T2406 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 5494 , 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: P00151040 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2498208 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2499998 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000341090 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00441299 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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