Provider Demographics
NPI:1275119554
Name:NORTHERN OHIO EYE CONSULTANTS INC
Entity Type:Organization
Organization Name:NORTHERN OHIO EYE CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-526-1974
Mailing Address - Street 1:7001 S EDGERTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-4206
Mailing Address - Country:US
Mailing Address - Phone:440-526-1974
Mailing Address - Fax:440-740-0662
Practice Address - Street 1:2600 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5311
Practice Address - Country:US
Practice Address - Phone:419-625-6181
Practice Address - Fax:440-740-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2410395Medicaid