Provider Demographics
NPI:1912127820
Name:PRIMARY EYECARE INC
Entity Type:Organization
Organization Name:PRIMARY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MICHALOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-671-2998
Mailing Address - Street 1:10680 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5411
Mailing Address - Country:US
Mailing Address - Phone:216-671-2998
Mailing Address - Fax:216-671-6985
Practice Address - Street 1:10680 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5411
Practice Address - Country:US
Practice Address - Phone:216-671-2998
Practice Address - Fax:216-671-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9267811Medicare ID - Type UnspecifiedGROUP NUMBER
OH0591880001Medicare NSC