Provider Demographics
NPI:1841460482
Name:DAYTON OPTOMETRIC CENTER INC.
Entity type:Organization
Organization Name:DAYTON OPTOMETRIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-293-8685
Mailing Address - Street 1:40 SOUTHMOOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2450
Mailing Address - Country:US
Mailing Address - Phone:937-293-8685
Mailing Address - Fax:937-293-2337
Practice Address - Street 1:2440 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-2459
Practice Address - Country:US
Practice Address - Phone:937-293-8685
Practice Address - Fax:937-293-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141626Medicaid
OH0141626Medicaid
OH9171812Medicare PIN