Provider Demographics
NPI:1346600517
Name:MIDWEST EYE CONSULTANTS OHIO, INC
Entity Type:Organization
Organization Name:MIDWEST EYE CONSULTANTS OHIO, INC
Other - Org Name:MIDWEST EYE CONSULTANTS OHIO #402
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-569-9550
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0432
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:
Practice Address - Street 1:1814 W LASKEY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3526
Practice Address - Country:US
Practice Address - Phone:419-693-4444
Practice Address - Fax:419-697-2149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EYE CONSULTANTS OHIO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-02
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163487Medicaid
OHH465030Medicare PIN