Provider Demographics
NPI:1093040255
Name:NICK J DONCH
Entity Type:Organization
Organization Name:NICK J DONCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-428-2526
Mailing Address - Street 1:103 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3115
Mailing Address - Country:US
Mailing Address - Phone:440-428-2526
Mailing Address - Fax:440-428-2526
Practice Address - Street 1:103 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3115
Practice Address - Country:US
Practice Address - Phone:440-428-2526
Practice Address - Fax:440-428-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2762332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0810650001Medicare NSC