Basic Information
| Provider Information | |||||||||
| NPI: | 1689998734 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYE CARE ASSOCIATES OF GREATER CINCINNATI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5535 FAIR LN | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452273434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132215274 | ||||||||
| FaxNumber: | 5139615100 | ||||||||
| Practice Location | |||||||||
| Address1: | 5240 E GALBRAITH RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137459787 | ||||||||
| FaxNumber: | 5137459789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 12/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5132215274 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 79944 | OH | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.