Provider Demographics
NPI:1336215151
Name:TUSCARAWAS EYE CENTRE INC
Entity Type:Organization
Organization Name:TUSCARAWAS EYE CENTRE INC
Other - Org Name:HEIGHTS EYE CLINIC INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-364-4434
Mailing Address - Street 1:340 OXFORD STREET
Mailing Address - Street 2:SUITE 340
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1963
Mailing Address - Country:US
Mailing Address - Phone:330-364-4434
Mailing Address - Fax:330-343-3424
Practice Address - Street 1:340 OXFORD STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1963
Practice Address - Country:US
Practice Address - Phone:330-364-4434
Practice Address - Fax:330-343-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE9611OtherR R
1417962OtherUMWA
OH0212068Medicaid
1417962OtherUMWA
=========OtherANTHEM
OH0212068Medicaid
OH0212068Medicaid
OH9933571Medicare PIN