Provider Demographics
NPI:1457520553
Name:DONCH AND BAKER, O.D. EYE DOCTORS OF MADISON, LLC
Entity Type:Organization
Organization Name:DONCH AND BAKER, O.D. EYE DOCTORS OF MADISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-428-2526
Mailing Address - Street 1:103 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3115
Mailing Address - Country:US
Mailing Address - Phone:440-428-2526
Mailing Address - Fax:440-428-2526
Practice Address - Street 1:103 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3115
Practice Address - Country:US
Practice Address - Phone:440-428-2526
Practice Address - Fax:440-428-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2257105Medicaid
OHOH2762OtherEYEMED
OH2257105Medicaid
OH=========027OtherCARESOURCE
OH=========027OtherCARESOURCE
OHOH2762OtherEYEMED
OHU20843Medicare UPIN
OH6244550001Medicare NSC