Provider Demographics
NPI:1033649645
Name:GLAUCOMA & EYE SPECIALISTS LLC
Entity Type:Organization
Organization Name:GLAUCOMA & EYE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-433-0000
Mailing Address - Street 1:4360 FULTON DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2878
Mailing Address - Country:US
Mailing Address - Phone:330-433-0000
Mailing Address - Fax:330-433-0400
Practice Address - Street 1:4360 FULTON DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-433-0000
Practice Address - Fax:330-433-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty