Provider Demographics
NPI:1073744017
Name:DR. MIKE LOCKHART, JR. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DR. MIKE LOCKHART, JR. & ASSOCIATES, INC.
Other - Org Name:MICHAEL LOCKHART OD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:330-833-1091
Mailing Address - Street 1:1151 MELSCHEIMER RD SW
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9752
Mailing Address - Country:US
Mailing Address - Phone:330-833-1091
Mailing Address - Fax:330-833-1092
Practice Address - Street 1:915 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6833
Practice Address - Country:US
Practice Address - Phone:330-833-1091
Practice Address - Fax:330-833-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642439Medicaid
OH2642439Medicaid