Provider Demographics
NPI:1326538703
Name:TOLEDO CLINIC INCORPORATED
Entity Type:Organization
Organization Name:TOLEDO CLINIC INCORPORATED
Other - Org Name:VISION INSTITUTE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-473-3561
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 MEIJER DRIVE
Practice Address - Street 2:STE 2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617
Practice Address - Country:US
Practice Address - Phone:567-225-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOLEDO CLINIC INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical