Provider Demographics
NPI:1710223763
Name:PREMIER HEALTH SPECIALISTS INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SPECIALISTS INC
Other - Org Name:OHIO EYECARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA
Authorized Official - Phone:937-499-9015
Mailing Address - Street 1:105 SUGAR CAMP CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1962
Mailing Address - Country:US
Mailing Address - Phone:937-222-3937
Mailing Address - Fax:937-496-3595
Practice Address - Street 1:105 SUGAR CAMP CIR
Practice Address - Street 2:STE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1962
Practice Address - Country:US
Practice Address - Phone:937-222-3937
Practice Address - Fax:937-496-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077398Medicaid