Provider Demographics
NPI:1730324401
Name:OHIO OPTOMETRIC CONSULTANTS INC.
Entity Type:Organization
Organization Name:OHIO OPTOMETRIC CONSULTANTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-933-3214
Mailing Address - Street 1:33398 WALKER RD
Mailing Address - Street 2:STE. B
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1496
Mailing Address - Country:US
Mailing Address - Phone:440-933-3214
Mailing Address - Fax:440-933-4924
Practice Address - Street 1:33398 WALKER RD
Practice Address - Street 2:STE. B
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1496
Practice Address - Country:US
Practice Address - Phone:440-933-3214
Practice Address - Fax:440-933-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4281T463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1185890004Medicare NSC
OH9302546Medicare PIN