Provider Demographics
NPI:1598836975
Name:DR STEIN OPTICAL CLINIC INC
Entity Type:Organization
Organization Name:DR STEIN OPTICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-364-2512
Mailing Address - Street 1:1249 MONROE ST NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-4139
Mailing Address - Country:US
Mailing Address - Phone:330-364-2512
Mailing Address - Fax:330-364-2078
Practice Address - Street 1:1249 MONROE ST NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-4139
Practice Address - Country:US
Practice Address - Phone:330-364-2512
Practice Address - Fax:330-364-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400131Medicaid
OH=========027Medicaid
OH=========028Medicaid
OH9281381Medicare PIN
OH0400131Medicaid