Provider Demographics
NPI:1154526408
Name:THE SURGICAL EYE CARE CENTER
Entity type:Organization
Organization Name:THE SURGICAL EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:REPKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-535-2521
Mailing Address - Street 1:95 ARCH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1479
Mailing Address - Country:US
Mailing Address - Phone:330-535-2521
Mailing Address - Fax:330-535-6845
Practice Address - Street 1:95 ARCH ST STE 120
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1479
Practice Address - Country:US
Practice Address - Phone:330-535-2521
Practice Address - Fax:330-535-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047918207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0658551Medicaid
OH1154526408Medicare PIN
OH0658551Medicaid