1942655477 NPI number — EYE PHYSICIANS & FACIAL PLASTIC SURGERY, LLC

Table of content: (NPI 1942655477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942655477 NPI number — EYE PHYSICIANS & FACIAL PLASTIC SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE PHYSICIANS & FACIAL PLASTIC SURGERY, 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:
1942655477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45401-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-274-2733
Provider Business Mailing Address Fax Number:
937-274-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-274-2733
Provider Business Practice Location Address Fax Number:
937-274-2737
Provider Enumeration Date:
05/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WATT
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-274-2733

Provider Taxonomy Codes

  • Taxonomy code: 207WX0200X , with the licence number:  35-071393W , 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: 2111324 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com