Provider Demographics
NPI:1184703969
Name:BELMONT EYE CLINIC INC
Entity type:Organization
Organization Name:BELMONT EYE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-759-7672
Mailing Address - Street 1:3020 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1846
Mailing Address - Country:US
Mailing Address - Phone:330-759-7672
Mailing Address - Fax:330-759-4768
Practice Address - Street 1:3020 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1846
Practice Address - Country:US
Practice Address - Phone:330-759-7672
Practice Address - Fax:330-759-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0832228Medicaid
OH0832228Medicaid
OH0397080001Medicare NSC