Provider Demographics
NPI:1043565260
Name:ODA EYE CARE, L.L.C.
Entity Type:Organization
Organization Name:ODA EYE CARE, L.L.C.
Other - Org Name:GROVE CITY VISION CARE, L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUKIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:ODA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-875-7888
Mailing Address - Street 1:1377 MARION WALDO RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7435
Mailing Address - Country:US
Mailing Address - Phone:740-389-5585
Mailing Address - Fax:
Practice Address - Street 1:1377 MARION WALDO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7435
Practice Address - Country:US
Practice Address - Phone:740-389-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-14
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty