Provider Demographics
NPI:1689937229
Name:THE EYE CLINIC INC
Entity Type:Organization
Organization Name:THE EYE CLINIC INC
Other - Org Name:PERRY EYE CLINIC INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:330-837-5191
Mailing Address - Street 1:3545 LINCOLN WAY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8624
Mailing Address - Country:US
Mailing Address - Phone:330-837-5191
Mailing Address - Fax:330-837-0755
Practice Address - Street 1:1605 PORTAGE RD NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-433-1350
Practice Address - Fax:330-305-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0935895Medicaid
OH9176931Medicare PIN
OH0439750001Medicare NSC