Provider Demographics
NPI:1003950460
Name:OPTICARE INC
Entity Type:Organization
Organization Name:OPTICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:740-392-7851
Mailing Address - Street 1:855 COSHOCTON AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1975
Mailing Address - Country:US
Mailing Address - Phone:740-392-7851
Mailing Address - Fax:740-392-3515
Practice Address - Street 1:855 COSHOCTON AVE STE 15
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1975
Practice Address - Country:US
Practice Address - Phone:740-392-7851
Practice Address - Fax:740-392-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3286SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384249Medicaid
OH0168230001Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER