Provider Demographics
NPI:1093927881
Name:PRIMARY EYECARE ASSOCIATES INC
Entity Type:Organization
Organization Name:PRIMARY EYECARE ASSOCIATES INC
Other - Org Name:KIRACOFE, BEIGEL, BARR & AHRNS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:AHRNS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-492-9197
Mailing Address - Street 1:PO BOX 4189
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-4189
Mailing Address - Country:US
Mailing Address - Phone:937-492-9197
Mailing Address - Fax:937-492-1901
Practice Address - Street 1:1086 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8913
Practice Address - Country:US
Practice Address - Phone:937-492-9197
Practice Address - Fax:937-492-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461987Medicaid
OH2454017Medicaid
OH0991431Medicaid
OH0762392Medicaid
OH0304601Medicaid
OH0266644Medicaid
OH0669683Medicaid
OH0669683Medicaid
OH2454017Medicaid