Provider Demographics
NPI:1053308668
Name:EYE CARE DOCTORS
Entity Type:Organization
Organization Name:EYE CARE DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-943-3663
Mailing Address - Street 1:30184 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1655
Mailing Address - Country:US
Mailing Address - Phone:440-943-3663
Mailing Address - Fax:440-943-3664
Practice Address - Street 1:30184 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1655
Practice Address - Country:US
Practice Address - Phone:440-943-3663
Practice Address - Fax:440-943-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2462/T475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500774Medicaid
OHT47183Medicare UPIN
OH0500774Medicaid