Provider Demographics
NPI:1326189499
Name:KUNESH EYE SURGERY CENTER
Entity Type:Organization
Organization Name:KUNESH EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUNESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-298-1093
Mailing Address - Street 1:2601 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1634
Mailing Address - Country:US
Mailing Address - Phone:937-298-1093
Mailing Address - Fax:937-298-6344
Practice Address - Street 1:2601 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1634
Practice Address - Country:US
Practice Address - Phone:937-298-1093
Practice Address - Fax:937-298-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6820012OtherUNITED HEALTH CARE
OH0818155Medicaid
6820012OtherUNITED HEALTH CARE