Provider Demographics
NPI: | 1710029640 |
---|---|
Name: | EOY,LLC |
Entity Type: | Organization |
Organization Name: | EOY,LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SHERRI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REED |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 614-488-1180 |
Mailing Address - Street 1: | 3026 GOLDEN OAK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HILLIARD |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43026-7981 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1374 GRANDVIEW AVE |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43212-2803 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-488-1180 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-14 |
Last Update Date: | 2007-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 4233 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 9313311 | Medicare PIN |