Provider Demographics
NPI:1942424932
Name:CENTRAL OHIO EYE SURGEONS INC
Entity Type:Organization
Organization Name:CENTRAL OHIO EYE SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-397-2425
Mailing Address - Street 1:1355 YAUGER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9233
Mailing Address - Country:US
Mailing Address - Phone:740-397-2425
Mailing Address - Fax:740-392-1915
Practice Address - Street 1:1355 YAUGER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9233
Practice Address - Country:US
Practice Address - Phone:740-397-2425
Practice Address - Fax:740-392-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0349233Medicaid
OH0380449Medicaid
OH9158632Medicare PIN
OH9158633Medicare ID - Type Unspecified
OH0349233Medicaid