Provider Demographics
NPI:1023681426
Name:EYES ON MAIN INC
Entity type:Organization
Organization Name:EYES ON MAIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KRETCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-888-3937
Mailing Address - Street 1:19 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CARNEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1919
Mailing Address - Country:US
Mailing Address - Phone:317-669-2312
Mailing Address - Fax:317-669-2528
Practice Address - Street 1:19 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARNEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1919
Practice Address - Country:US
Practice Address - Phone:317-669-2312
Practice Address - Fax:317-669-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty