Provider Demographics
NPI:1689175432
Name:POLARIS EYE CARE
Entity Type:Organization
Organization Name:POLARIS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:SHEWRING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-880-1493
Mailing Address - Street 1:1070 POLARIS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4039
Mailing Address - Country:US
Mailing Address - Phone:614-880-1493
Mailing Address - Fax:614-880-9018
Practice Address - Street 1:1070 POLARIS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4039
Practice Address - Country:US
Practice Address - Phone:614-880-1493
Practice Address - Fax:614-880-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSH4174622Medicaid