Provider Demographics
NPI:1427035591
Name:EYE CENTER OF COLUMBUS, LLC
Entity Type:Organization
Organization Name:EYE CENTER OF COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASC PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-827-6600
Mailing Address - Street 1:PO BOX 932112
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-2112
Mailing Address - Country:US
Mailing Address - Phone:614-827-6600
Mailing Address - Fax:614-827-6690
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:STE 500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7313
Practice Address - Country:US
Practice Address - Phone:614-827-6600
Practice Address - Fax:614-827-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0772AS261QA1903X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2627634Medicaid
OH3612041Medicare PIN
OHEY3612041Medicare ID - Type Unspecified