Provider Demographics
NPI:1962825802
Name:CUSTOMEYES VISION CENTER, INC.
Entity Type:Organization
Organization Name:CUSTOMEYES VISION CENTER, INC.
Other - Org Name:LIBERTY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-759-5100
Mailing Address - Street 1:7604 COX LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6547
Mailing Address - Country:US
Mailing Address - Phone:513-759-5100
Mailing Address - Fax:513-759-5801
Practice Address - Street 1:7604 COX LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6547
Practice Address - Country:US
Practice Address - Phone:513-759-5100
Practice Address - Fax:513-759-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty