Provider Demographics
NPI:1558464636
Name:THE EYE CLINIC, INC.
Entity type:Organization
Organization Name:THE EYE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-837-5191
Mailing Address - Street 1:3545 LINCOLN WAY E STE A
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8624
Mailing Address - Country:US
Mailing Address - Phone:330-837-5191
Mailing Address - Fax:330-837-0755
Practice Address - Street 1:830 AMHERST RD NE
Practice Address - Street 2:SUITE 204
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8518
Practice Address - Country:US
Practice Address - Phone:330-837-6812
Practice Address - Fax:330-837-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM0456OtherRAILROAD MEDICARE
OH2355142Medicaid
OHCM0456OtherRAILROAD MEDICARE
OH2355142Medicaid