Provider Demographics
NPI:1659329415
Name:DAYTON EYECARE, INC
Entity Type:Organization
Organization Name:DAYTON EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-898-2300
Mailing Address - Street 1:8216 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1641
Mailing Address - Country:US
Mailing Address - Phone:937-898-2300
Mailing Address - Fax:937-898-2348
Practice Address - Street 1:8216 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1641
Practice Address - Country:US
Practice Address - Phone:937-898-2300
Practice Address - Fax:937-898-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5391-P207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH38552917200OtherWORKERS COMP
OH385529172002OtherMMOH
OH0129515Medicaid
OH0820241OtherUHC
OH4663078OtherAETNA
OH000000019509OtherANTHEM
OH0820241OtherUHC
9277211Medicare PIN