Provider Demographics
NPI:1265629372
Name:WING EYECARE, INC.
Entity Type:Organization
Organization Name:WING EYECARE, INC.
Other - Org Name:WING EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:NAGY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-921-8433
Mailing Address - Street 1:768 NW WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1278
Mailing Address - Country:US
Mailing Address - Phone:513-893-8816
Mailing Address - Fax:
Practice Address - Street 1:768 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1278
Practice Address - Country:US
Practice Address - Phone:513-893-8816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
153748494001OtherMEDICAL MUTUAL
153748494001OtherMEDICAL MUTUAL