Provider Demographics
NPI:1013002492
Name:UNIQUE-U LLC
Entity Type:Organization
Organization Name:UNIQUE-U LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERAMIAH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DONELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:740-389-1300
Mailing Address - Street 1:163 JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-389-1300
Mailing Address - Fax:
Practice Address - Street 1:163 JAMES WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-389-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS7159156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621416Medicaid
OH5790510001Medicare NSC