Provider Demographics
NPI:1538292891
Name:MY OPTIX INC
Entity Type:Organization
Organization Name:MY OPTIX INC
Other - Org Name:GEAUGA VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:330-527-2020
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:14901 STATE AVENUE N.
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-1210
Mailing Address - Country:US
Mailing Address - Phone:440-632-1695
Mailing Address - Fax:440-632-1690
Practice Address - Street 1:14901 STATE AVENUE N
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-1210
Practice Address - Country:US
Practice Address - Phone:440-632-1695
Practice Address - Fax:440-632-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3884-SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2557148Medicaid
OH0140252Medicaid
OH0958850001Medicare NSC