Provider Demographics
NPI:1790889491
Name:BUCKEYE VISION CARE
Entity Type:Organization
Organization Name:BUCKEYE VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:MESARCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-385-4006
Mailing Address - Street 1:30652 RED ROCK CT
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9670
Mailing Address - Country:US
Mailing Address - Phone:740-385-4006
Mailing Address - Fax:740-385-4043
Practice Address - Street 1:30652 RED ROCK CT
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9670
Practice Address - Country:US
Practice Address - Phone:740-385-4006
Practice Address - Fax:740-385-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622997Medicaid
OHVO7158Medicare UPIN
5838170001Medicare NSC
OHME4172281Medicare ID - Type Unspecified