Provider Demographics
NPI:1134815806
Name:ILEY, ERIN MARIE
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:MARIE
Last Name:ILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 MACEDONIA COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1843
Mailing Address - Country:US
Mailing Address - Phone:330-468-0404
Mailing Address - Fax:330-468-0211
Practice Address - Street 1:8160 MACEDONIA COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1843
Practice Address - Country:US
Practice Address - Phone:330-468-0404
Practice Address - Fax:330-468-0211
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC.6437156FX1800X
OHSC.06437156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty