Provider Demographics
NPI:1295717080
Name:GAHANNA EYECARE ASSOCIATES LLC
Entity type:Organization
Organization Name:GAHANNA EYECARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-475-8134
Mailing Address - Street 1:120 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2602
Mailing Address - Country:US
Mailing Address - Phone:614-475-8134
Mailing Address - Fax:614-475-8326
Practice Address - Street 1:120 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2602
Practice Address - Country:US
Practice Address - Phone:614-475-8134
Practice Address - Fax:614-475-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGA9308091Medicare ID - Type UnspecifiedGROUP PROVIDER NO.