Provider Demographics
NPI:1356488035
Name:CHILDREN'S EYE CARE CENTER OF NORTHWEST OHIO, INC.
Entity Type:Organization
Organization Name:CHILDREN'S EYE CARE CENTER OF NORTHWEST OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-872-9777
Mailing Address - Street 1:842 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5265
Mailing Address - Country:US
Mailing Address - Phone:419-872-9777
Mailing Address - Fax:419-872-9781
Practice Address - Street 1:842 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5265
Practice Address - Country:US
Practice Address - Phone:419-872-9777
Practice Address - Fax:419-872-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053982W207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240046Medicaid