Provider Demographics
NPI:1679860753
Name:COMBS, ERIC T (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
Last Name:COMBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SUMMITT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3464
Mailing Address - Country:US
Mailing Address - Phone:513-424-6267
Mailing Address - Fax:513-425-9235
Practice Address - Street 1:1015 SUMMITT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3464
Practice Address - Country:US
Practice Address - Phone:513-424-6267
Practice Address - Fax:513-425-9235
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104074Medicaid