Provider Demographics
NPI:1083890297
Name:STEPHEN N. CAJACOB, O.D.
Entity Type:Organization
Organization Name:STEPHEN N. CAJACOB, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAJACOB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-228-8116
Mailing Address - Street 1:1034 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2730
Mailing Address - Country:US
Mailing Address - Phone:419-228-8116
Mailing Address - Fax:419-228-1160
Practice Address - Street 1:1034 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2730
Practice Address - Country:US
Practice Address - Phone:419-228-8116
Practice Address - Fax:419-228-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2935T377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231270Medicaid
OHT46910Medicare UPIN
OH0231270Medicaid