Provider Demographics
NPI:1457466278
Name:THE EYESITE OF DUBLIN
Entity Type:Organization
Organization Name:THE EYESITE OF DUBLIN
Other - Org Name:THE EYESITE OF DUBLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-764-7483
Mailing Address - Street 1:6535 PERIMETER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016
Mailing Address - Country:US
Mailing Address - Phone:614-764-7483
Mailing Address - Fax:614-764-7485
Practice Address - Street 1:6535 PERIMETER DR
Practice Address - Street 2:AVERY SQUARE PLAZA
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-764-7483
Practice Address - Fax:614-764-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9351791Medicare PIN
OHY30163Medicare UPIN