Provider Demographics
NPI:1740226406
Name:LEAR, VICKI L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:LEAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W HIGH ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4340
Mailing Address - Country:US
Mailing Address - Phone:419-998-4573
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:525 N EASTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2268
Practice Address - Country:US
Practice Address - Phone:419-998-4699
Practice Address - Fax:419-998-4688
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-131085363A00000X
OH50001817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH747559OtherBUCKEYE
OHP00211485OtherRAILROAD MEDICARE
OH000000666385OtherANTHEM
OH747559OtherBUCKEYE
P63939Medicare UPIN
LEPA19263Medicare PIN