Provider Demographics
NPI:1912111725
Name:PATABI RAJ SEETHARAMAN
Entity Type:Organization
Organization Name:PATABI RAJ SEETHARAMAN
Other - Org Name:MID-OHIO EYE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATABI
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:SEETHARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-468-5200
Mailing Address - Street 1:32280 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1356
Mailing Address - Country:US
Mailing Address - Phone:440-248-2542
Mailing Address - Fax:
Practice Address - Street 1:251 PORTLAND WAY N
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1632
Practice Address - Country:US
Practice Address - Phone:419-468-5200
Practice Address - Fax:419-468-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4617T1363152W00000X
OH35057803207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2006895Medicaid
OH0897374Medicaid
OH2006895Medicaid
OHU41566Medicare UPIN
OH9287991Medicare PIN
OH0897374Medicaid
OH0930640001Medicare NSC
OH0794643Medicare PIN