1780806067 NPI number — EYE SITE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780806067 NPI number — EYE SITE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE SITE, 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:
1780806067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12464 LANCASTER ST
Provider Second Line Business Mailing Address:
PO BOX 421
Provider Business Mailing Address City Name:
MILLERSPORT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43046-9787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-467-2525
Provider Business Mailing Address Fax Number:
740-467-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12464 LANCASTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLERSPORT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43046-9787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-467-2525
Provider Business Practice Location Address Fax Number:
740-467-3015
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIETZ
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-467-2525

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5109 , 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: 0294346 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2235414 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com