1427374826 NPI number — CLEARVIEW EYE CARE

Table of content: (NPI 1427374826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427374826 NPI number — CLEARVIEW EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARVIEW EYE CARE
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:
1427374826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45071-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6180 GLENWAY AVE
Provider Second Line Business Practice Location Address:
UNIT H
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45211-6320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-662-0157
Provider Business Practice Location Address Fax Number:
513-389-3396
Provider Enumeration Date:
04/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MICAH
Authorized Official First Name:
KWEKU
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-488-9157

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5732 , 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: 3005116 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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