1528270311 NPI number — PRIMARY EYECARE ASSOCIATES INC

Table of content: (NPI 1528270311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528270311 NPI number — PRIMARY EYECARE ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY EYECARE ASSOCIATES INC
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:
1528270311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 FAIRINGTON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-492-9197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 S. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. LORAMIE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-295-3307
Provider Business Practice Location Address Fax Number:
937-492-1901
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHRNS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-492-9197

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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: 0461987 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0304601 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2454017 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0669683 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0991431 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0266644 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0762492 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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