Provider Demographics
NPI:1689144149
Name:EYE TO EYE VISIONCARE
Entity Type:Organization
Organization Name:EYE TO EYE VISIONCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-339-8788
Mailing Address - Street 1:400 MILL AVE SE STE 329
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3876
Mailing Address - Country:US
Mailing Address - Phone:330-339-8788
Mailing Address - Fax:
Practice Address - Street 1:400 MILL AVE SE STE 329
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3876
Practice Address - Country:US
Practice Address - Phone:330-339-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3259OtherSTATE LICENSE
OH6343OtherSTATE LICENSE