Provider Demographics
NPI:1477734838
Name:CHESTER EYE CENTER INC
Entity Type:Organization
Organization Name:CHESTER EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-773-2020
Mailing Address - Street 1:261 N WOODBRIDGE AVE
Mailing Address - Street 2:PO BOX 915
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2246
Mailing Address - Country:US
Mailing Address - Phone:740-773-2020
Mailing Address - Fax:740-773-8957
Practice Address - Street 1:261 N WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2246
Practice Address - Country:US
Practice Address - Phone:740-773-2020
Practice Address - Fax:740-773-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3403 T383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400524Medicaid
OH0400524Medicaid
OH0163230001Medicare NSC