Provider Demographics
NPI:1508983768
Name:SSK OPTOMETRY, LTD.
Entity Type:Organization
Organization Name:SSK OPTOMETRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KINROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-893-4820
Mailing Address - Street 1:2656 AMBERWICK PL
Mailing Address - Street 2:SAMANTHA KINROSS O.D.
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8894
Mailing Address - Country:US
Mailing Address - Phone:614-893-4820
Mailing Address - Fax:
Practice Address - Street 1:5123 TUTTLE CROSSING BLVD
Practice Address - Street 2:SAMANTHA KINROSS O.D.
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1535
Practice Address - Country:US
Practice Address - Phone:614-734-1570
Practice Address - Fax:614-734-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4877 T1742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty