Provider Demographics
NPI:1851811392
Name:THE EYE SITE AT NEW SEASONS LLC
Entity Type:Organization
Organization Name:THE EYE SITE AT NEW SEASONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-319-4442
Mailing Address - Street 1:1485 S HAWKINS AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3473
Mailing Address - Country:US
Mailing Address - Phone:330-208-9427
Mailing Address - Fax:330-208-9428
Practice Address - Street 1:1485 S HAWKINS AVE STE 130
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3473
Practice Address - Country:US
Practice Address - Phone:330-208-9427
Practice Address - Fax:330-208-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2933428Medicaid