Provider Demographics
NPI:1013483437
Name:NYE EYE ANESTHESIA INC
Entity Type:Organization
Organization Name:NYE EYE ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:234-284-9236
Mailing Address - Street 1:1320 LAKE ROGER DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6250
Mailing Address - Country:US
Mailing Address - Phone:234-284-9236
Mailing Address - Fax:330-288-0327
Practice Address - Street 1:789 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1045
Practice Address - Country:US
Practice Address - Phone:330-923-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty