Provider Demographics
NPI:1427374826
Name:CLEARVIEW EYE CARE
Entity Type:Organization
Organization Name:CLEARVIEW EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWEKU
Authorized Official - Middle Name:
Authorized Official - Last Name:MICAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-488-9157
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45071-0688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6180 GLENWAY AVE
Practice Address - Street 2:UNIT H
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6320
Practice Address - Country:US
Practice Address - Phone:513-662-0157
Practice Address - Fax:513-389-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3005116Medicaid