Provider Demographics
NPI:1619018090
Name:OHIO EYE OPTOMETRIC, LLC
Entity Type:Organization
Organization Name:OHIO EYE OPTOMETRIC, LLC
Other - Org Name:HOMETOWN EYE CARE
Other - Org Type:Doing Business As
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:MD
Authorized Official - Phone:419-756-8000
Mailing Address - Street 1:58 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1213
Mailing Address - Country:US
Mailing Address - Phone:419-947-8330
Mailing Address - Fax:419-947-8355
Practice Address - Street 1:58 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1213
Practice Address - Country:US
Practice Address - Phone:419-947-8330
Practice Address - Fax:419-947-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3826152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0627101Medicaid
OHHO9347621Medicare PIN
OH5274170001Medicare NSC
OHU20938Medicare UPIN