Provider Demographics
NPI:1073591541
Name:ASHLAND EYECARE INC
Entity Type:Organization
Organization Name:ASHLAND EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRY
Authorized Official - Phone:419-289-0808
Mailing Address - Street 1:2212 MIFFLIN AVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-2736
Mailing Address - Country:US
Mailing Address - Phone:419-289-0808
Mailing Address - Fax:
Practice Address - Street 1:2212 MIFFLIN AVE SUITE 110
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-2736
Practice Address - Country:US
Practice Address - Phone:419-289-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468855Medicaid
OH0601590001Medicare NSC
OH0468855Medicaid