Provider Demographics
NPI:1518925429
Name:TRINITY EYE CARE,LLC
Entity Type:Organization
Organization Name:TRINITY EYE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:KWONG
Authorized Official - Last Name:OR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-427-2828
Mailing Address - Street 1:1538 MARSETTA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2733
Mailing Address - Country:US
Mailing Address - Phone:937-427-2828
Mailing Address - Fax:937-427-2880
Practice Address - Street 1:1538 MARSETTA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2733
Practice Address - Country:US
Practice Address - Phone:937-427-2828
Practice Address - Fax:937-427-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008241O207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherGEHA
OH=========OtherOHIO BUREAU OF WORKER'S C
OH=========OtherAETNA
OH=========OtherHUMANA
OH=========OtherFIRST HEALTH
OH=========OtherNATIONWIDE HEALTH PLAN
OH=========OtherUNITED HEALTHCARE
OH=========OtherAARP
OH=========OtherBENEFIT PLANNERS
OH=========OtherMCS LIFE INSURANCE
OH=========OtherPRIVATE HEALTHCARE SYSTEM
OH=========OtherTRICARE
OH=========OtherHUMANA