Provider Demographics
NPI:1801015896
Name:OHIO OPTOMETRIC CONSULTANTS INC
Entity Type:Organization
Organization Name:OHIO OPTOMETRIC CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-653-8500
Mailing Address - Street 1:126 W STREETSBORO ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2720
Mailing Address - Country:US
Mailing Address - Phone:330-653-8500
Mailing Address - Fax:
Practice Address - Street 1:126 W STREETSBORO ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2720
Practice Address - Country:US
Practice Address - Phone:330-653-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC5592OtherRAIL ROAD MEDICARE
9302543Medicare PIN
OH1185890003Medicare NSC
OHDC5592Medicare PIN
OHDC5592OtherRAIL ROAD MEDICARE
OH1185890004Medicare NSC
9302546Medicare PIN