Provider Demographics
NPI:1750312534
Name:ADVANCED EYE CARE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED EYE CARE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLITCH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:419-512-2927
Mailing Address - Street 1:1991 PARK AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-521-3937
Mailing Address - Fax:419-522-5189
Practice Address - Street 1:1991 PARK AVENUE WEST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-521-3937
Practice Address - Fax:419-522-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0796AS261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAD3612131Medicare PIN