Provider Demographics
NPI:1861030462
Name:EYES ON MAIN OPTICAL LLC
Entity Type:Organization
Organization Name:EYES ON MAIN OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-772-2100
Mailing Address - Street 1:921 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2843
Mailing Address - Country:US
Mailing Address - Phone:740-772-2100
Mailing Address - Fax:
Practice Address - Street 1:921 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2843
Practice Address - Country:US
Practice Address - Phone:740-772-2100
Practice Address - Fax:740-772-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier