Provider Demographics
NPI:1477735538
Name:EYES ON MAIN, LLC
Entity Type:Organization
Organization Name:EYES ON MAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:WIRES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-422-2015
Mailing Address - Street 1:334 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3353
Mailing Address - Country:US
Mailing Address - Phone:419-422-2015
Mailing Address - Fax:419-427-9477
Practice Address - Street 1:334 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3353
Practice Address - Country:US
Practice Address - Phone:419-422-2015
Practice Address - Fax:419-427-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3756T705152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH055775Medicaid
OHEY9376651Medicare Oscar/Certification
OHY48178Medicare UPIN