Provider Demographics
NPI:1972634863
Name:EYE CARE ASSOCIATES OF GREATER CINCINNATI, INC
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF GREATER CINCINNATI, INC
Other - Org Name:OPTICAL SHOP MASON
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-221-5274
Mailing Address - Street 1:5535 FAIR LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3434
Mailing Address - Country:US
Mailing Address - Phone:513-221-5274
Mailing Address - Fax:513-961-5100
Practice Address - Street 1:6394 THORNBERRY CT
Practice Address - Street 2:SUITE 810
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7810
Practice Address - Country:US
Practice Address - Phone:513-770-4020
Practice Address - Fax:513-770-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5614950002Medicare NSC