Provider Demographics
NPI:1427443472
Name:OHIO EYE OPTOMETRIC, LLC
Entity type:Organization
Organization Name:OHIO EYE OPTOMETRIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-756-8000
Mailing Address - Street 1:466 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3416
Mailing Address - Country:US
Mailing Address - Phone:419-756-8000
Mailing Address - Fax:419-756-2601
Practice Address - Street 1:38 SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:OH
Practice Address - Zip Code:44865-1170
Practice Address - Country:US
Practice Address - Phone:419-756-8000
Practice Address - Fax:419-756-2601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO EYE ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39019705332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier