Provider Demographics
NPI:1699872887
Name:SHARONVILLE EVENDALE EYECARE CENTER, INC
Entity type:Organization
Organization Name:SHARONVILLE EVENDALE EYECARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-563-2304
Mailing Address - Street 1:10675 MCSWAIN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3168
Mailing Address - Country:US
Mailing Address - Phone:513-536-2304
Mailing Address - Fax:513-563-2356
Practice Address - Street 1:10675 MCSWAIN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3168
Practice Address - Country:US
Practice Address - Phone:513-536-2304
Practice Address - Fax:513-563-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4672/T1447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0771590001OtherDMERC SUPPLIER NUMBER