Provider Demographics
NPI:1710062013
Name:AKRON PEDIATRIC OPHTHALMOLOGY AND OPHTHALMIC PLASTIC SURGERY, INC
Entity Type:Organization
Organization Name:AKRON PEDIATRIC OPHTHALMOLOGY AND OPHTHALMIC PLASTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BURNSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-535-8000
Mailing Address - Street 1:215 WEST BOWERY ST LEVEL II
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1062
Mailing Address - Country:US
Mailing Address - Phone:330-535-8000
Mailing Address - Fax:330-553-2121
Practice Address - Street 1:215 WEST BOWERY ST LEVEL II
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1062
Practice Address - Country:US
Practice Address - Phone:330-535-8000
Practice Address - Fax:330-553-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0222075Medicaid
OHAK9264001Medicare ID - Type Unspecified