Provider Demographics
NPI:1598770224
Name:MIDDLETOWN EYECARE INC
Entity Type:Organization
Organization Name:MIDDLETOWN EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BJORK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-424-0339
Mailing Address - Street 1:315 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3868
Mailing Address - Country:US
Mailing Address - Phone:513-424-0339
Mailing Address - Fax:513-424-4910
Practice Address - Street 1:315 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3868
Practice Address - Country:US
Practice Address - Phone:513-424-0339
Practice Address - Fax:513-424-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000270784OtherANTHEM BC/BS GROUP
OH2374425Medicaid
OH4689330001Medicare NSC
CK8434Medicare ID - Type UnspecifiedRAILROAD GROUP
OH2374425Medicaid