Provider Demographics
NPI:1073713400
Name:OPHTHALMOLOGY AND OCULOPLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY AND OCULOPLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HONKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:482-395-5175
Mailing Address - Street 1:150 7TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2908
Mailing Address - Country:US
Mailing Address - Phone:440-285-2020
Mailing Address - Fax:440-285-8448
Practice Address - Street 1:150 7TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2908
Practice Address - Country:US
Practice Address - Phone:440-285-2020
Practice Address - Fax:440-285-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5012T188152W00000X
OH35060480207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCG4745OtherRAILROAD MEDICARE
OH2841689Medicaid
OHF43052Medicare UPIN
OH9306722Medicare PIN
OH2841689Medicaid
OH9306721Medicare PIN