Provider Demographics
NPI:1679765994
Name:OAKWOOD EYE CLINIC
Entity Type:Organization
Organization Name:OAKWOOD EYE CLINIC
Other - Org Name:OAKWOOD EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSCIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STUDEBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-298-0550
Mailing Address - Street 1:2525 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1505
Mailing Address - Country:US
Mailing Address - Phone:937-298-0550
Mailing Address - Fax:
Practice Address - Street 1:2525 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1505
Practice Address - Country:US
Practice Address - Phone:937-298-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKWOOD EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3639 T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47824Medicare UPIN
OH4040270001Medicare NSC
OH9283311Medicare PIN