Provider Demographics
NPI:1508986829
Name:MT STERLING EYECARE LLC
Entity Type:Organization
Organization Name:MT STERLING EYECARE LLC
Other - Org Name:MT STERLING EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-869-4882
Mailing Address - Street 1:277 YANKEETOWN ST
Mailing Address - Street 2:PO BOX 146
Mailing Address - City:MT STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:43143-9410
Mailing Address - Country:US
Mailing Address - Phone:740-869-4882
Mailing Address - Fax:740-869-7698
Practice Address - Street 1:277 YANKEETOWN ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:OH
Practice Address - Zip Code:43143-9410
Practice Address - Country:US
Practice Address - Phone:740-869-4882
Practice Address - Fax:740-869-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2756T356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194236Medicaid
0286870001Medicare NSC
OH2194236Medicaid
OH9306292Medicare PIN