Provider Demographics
NPI:1770123770
Name:EMX EYE CARE PC
Entity type:Organization
Organization Name:EMX EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-729-5303
Mailing Address - Street 1:3464 PENTAGON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1790
Mailing Address - Country:US
Mailing Address - Phone:937-429-4060
Mailing Address - Fax:
Practice Address - Street 1:3464 PENTAGON BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1790
Practice Address - Country:US
Practice Address - Phone:937-429-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier