Provider Demographics
NPI:1275523896
Name:BALLITCH, HAROLD A II (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
Last Name:BALLITCH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2233
Mailing Address - Country:US
Mailing Address - Phone:419-564-2855
Mailing Address - Fax:419-522-5189
Practice Address - Street 1:1991 PARK AVE W
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-2233
Practice Address - Country:US
Practice Address - Phone:419-521-3937
Practice Address - Fax:419-522-5189
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063411207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0878420Medicaid
OH180026968Medicare PIN
OH9312992Medicare ID - Type Unspecified