Provider Demographics
NPI:1194722603
Name:DAYTON OPTOMETRIC CENTER INC.
Entity type:Organization
Organization Name:DAYTON OPTOMETRIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, D.O.C. JNC
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-228-2020
Mailing Address - Street 1:813 TROY ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1852
Mailing Address - Country:US
Mailing Address - Phone:937-228-2020
Mailing Address - Fax:937-228-8769
Practice Address - Street 1:813 TROY ST.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1852
Practice Address - Country:US
Practice Address - Phone:937-228-2020
Practice Address - Fax:937-228-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8733400Medicaid
OH8733400Medicaid
OH0225260002Medicare NSC