Provider Demographics
NPI:1225052939
Name:JEFFREY H. STOCKFISH MD, INC
Entity Type:Organization
Organization Name:JEFFREY H. STOCKFISH MD, INC
Other - Org Name:NORTHERN OHIO RETINAL CONSULTANTS
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:H
Authorized Official - Last Name:STOCKFISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-460-2822
Mailing Address - Street 1:6690 BETA DR
Mailing Address - Street 2:STE 312
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2361
Mailing Address - Country:US
Mailing Address - Phone:440-460-2822
Mailing Address - Fax:440-460-2825
Practice Address - Street 1:6690 BETA DR
Practice Address - Street 2:STE 312
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2361
Practice Address - Country:US
Practice Address - Phone:440-460-2822
Practice Address - Fax:440-460-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2647-S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0816755Medicaid
OH180039483OtherRAIL ROAD MEDICARE ID #
OH2834436900OtherWORKERS COMP ID
OH0816755Medicaid
OHE76576Medicare UPIN
OH000000136445OtherBLUE CROSS & BLUE SHIELD
OH283443690004OtherMEDICAL MUTUAL OF OHIO