Provider Demographics
NPI:1790738813
Name:EXCELLENCE IN EYE CARE
Entity Type:Organization
Organization Name:EXCELLENCE IN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-722-1313
Mailing Address - Street 1:3609 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8181
Mailing Address - Country:US
Mailing Address - Phone:330-722-1313
Mailing Address - Fax:330-723-3003
Practice Address - Street 1:3609 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8181
Practice Address - Country:US
Practice Address - Phone:330-722-1313
Practice Address - Fax:330-723-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00638575OtherRAILROAD MEDICARE
OH9361731Medicare PIN
OH5835490001Medicare NSC