Provider Demographics
NPI:1154520294
Name:OCULAR SERVICES MANAGEMENT INCORPORATED
Entity type:Organization
Organization Name:OCULAR SERVICES MANAGEMENT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MOGYORDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-892-5367
Mailing Address - Street 1:26927 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2370
Mailing Address - Country:US
Mailing Address - Phone:440-892-5367
Mailing Address - Fax:440-249-5094
Practice Address - Street 1:26927 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2370
Practice Address - Country:US
Practice Address - Phone:440-892-5367
Practice Address - Fax:440-249-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4481T1137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0992403Medicaid
OH2539908Medicaid
OH2442486Medicaid
OH4153593Medicare PIN
OH9302822Medicare PIN
OH2539908Medicaid