Provider Demographics
NPI:1750412789
Name:ADVANCED EYE CARE CENTER, INC
Entity type:Organization
Organization Name:ADVANCED EYE CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BALLITCH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:419-564-2855
Mailing Address - Street 1:1991 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2233
Mailing Address - Country:US
Mailing Address - Phone:419-521-3937
Mailing Address - Fax:419-522-5189
Practice Address - Street 1:1991 PARK AVE W
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-2233
Practice Address - Country:US
Practice Address - Phone:419-521-3937
Practice Address - Fax:419-522-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063411B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180026968Medicare PIN
OHE94175Medicare UPIN
OH9312992Medicare PIN
OH1275523896Medicare PIN