Provider Demographics
NPI:1346269495
Name:MEDINA EYE ASSOCIATES INC.
Entity Type:Organization
Organization Name:MEDINA EYE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:330-725-7748
Mailing Address - Street 1:970 E WASHINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2171
Mailing Address - Country:US
Mailing Address - Phone:330-725-7748
Mailing Address - Fax:330-722-5552
Practice Address - Street 1:970 E WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2171
Practice Address - Country:US
Practice Address - Phone:330-725-7748
Practice Address - Fax:330-722-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049330B207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0947131Medicaid
OH9916362Medicare PIN
OHA17340Medicare UPIN
OHCL1335Medicare PIN
OH0947131Medicaid