Provider Demographics
NPI:1629057716
Name:NORTHERN OHIO EYE CONSULTANTS INC
Entity Type:Organization
Organization Name:NORTHERN OHIO EYE CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-526-1974
Mailing Address - Street 1:1710 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3680
Mailing Address - Country:US
Mailing Address - Phone:440-960-2020
Mailing Address - Fax:440-282-3300
Practice Address - Street 1:1710 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3680
Practice Address - Country:US
Practice Address - Phone:440-960-2020
Practice Address - Fax:440-282-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD1244OtherRR MEDICARE
OH5426680001OtherDMERC
OH2410395Medicaid
OH5426680001OtherDMERC