1467528182 NPI number — BARBERTON EYE CENTER, LLC

Table of content: (NPI 1467528182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467528182 NPI number — BARBERTON EYE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBERTON EYE CENTER, LLC
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:
1467528182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 CONSERVATORY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBERTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44203-4281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-745-4404
Provider Business Mailing Address Fax Number:
330-753-9162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SPRINGSIDE DR
Provider Second Line Business Practice Location Address:
SUITE C300
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-666-0707
Provider Business Practice Location Address Fax Number:
330-668-4884
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALAWAY
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-745-4404

Provider Taxonomy Codes

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

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

  • Identifier: 2138663 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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