Provider Demographics
NPI:1689657058
Name:CENTER FOR ADVANCED EYE SURGERY, LTD
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED EYE SURGERY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-746-7691
Mailing Address - Street 1:1031 W WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3541
Mailing Address - Country:US
Mailing Address - Phone:330-965-0900
Mailing Address - Fax:330-743-8368
Practice Address - Street 1:1031 W WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3541
Practice Address - Country:US
Practice Address - Phone:330-965-0900
Practice Address - Fax:330-743-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0548AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145182Medicaid
OH490004288OtherRAILROAD MEDICARE
OH2145182Medicaid
OH1541754OtherUNITED MINE WORKERS
OH490004288OtherRAILROAD MEDICARE
OH000000157537OtherANTHEM
OH1541754OtherUNITED MINE WORKERS
OH=========00OtherBWC