Provider Demographics
NPI:1609208297
Name:OHIO EYE OPTOMETRIC LLC
Entity Type:Organization
Organization Name:OHIO EYE OPTOMETRIC LLC
Other - Org Name:OEO OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-756-8000
Mailing Address - Street 1:466 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3416
Mailing Address - Country:US
Mailing Address - Phone:419-756-8000
Mailing Address - Fax:
Practice Address - Street 1:466 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3416
Practice Address - Country:US
Practice Address - Phone:419-756-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO EYE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS3838OtherOHIO OPTICAL DISPENSERS BOARD