Provider Demographics
NPI:1962665935
Name:ISADORE JOHN YOUSHAK
Entity Type:Organization
Organization Name:ISADORE JOHN YOUSHAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISADORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-632-0194
Mailing Address - Street 1:15795 W HIGH ST
Mailing Address - Street 2:PO BOX 276
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9294
Mailing Address - Country:US
Mailing Address - Phone:440-632-0194
Mailing Address - Fax:
Practice Address - Street 1:15795 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9294
Practice Address - Country:US
Practice Address - Phone:440-632-0194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2777T980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0132181Medicaid
OHT46210Medicare UPIN
OH0368681Medicare PIN
OH0534760001Medicare NSC