Provider Demographics
NPI:1922089788
Name:NORTH CENTRAL EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:OBENAUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-668-3295
Mailing Address - Street 1:278 BENEDICT AVE
Mailing Address - Street 2:STE. 300 MEDICAL PARK III
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2399
Mailing Address - Country:US
Mailing Address - Phone:419-668-3295
Mailing Address - Fax:419-668-8861
Practice Address - Street 1:278 BENEDICT AVE
Practice Address - Street 2:STE. 300 MEDICAL PARK III
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2399
Practice Address - Country:US
Practice Address - Phone:419-668-3295
Practice Address - Fax:419-668-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCF1305OtherPALMETO GBA RAILROAD
OH0709031Medicaid
OHCF1305OtherPALMETO GBA RAILROAD
OH9927012Medicare ID - Type Unspecified
OH0709031Medicaid