Provider Demographics
NPI:1477692531
Name:RABER EYE CARE INC
Entity Type:Organization
Organization Name:RABER EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:RABER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-857-0123
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KIDRON
Mailing Address - State:OH
Mailing Address - Zip Code:44636-0010
Mailing Address - Country:US
Mailing Address - Phone:330-857-0123
Mailing Address - Fax:330-857-0246
Practice Address - Street 1:3693 KIDRON RD.
Practice Address - Street 2:
Practice Address - City:KIDRON
Practice Address - State:OH
Practice Address - Zip Code:44636-0010
Practice Address - Country:US
Practice Address - Phone:330-857-0123
Practice Address - Fax:330-857-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4582T1325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9359981Medicare PIN
OH5650470001Medicare NSC