Provider Demographics
NPI:1366218687
Name:NORTHEAST OHIO EYE SURGEONS, INC.
Entity type:Organization
Organization Name:NORTHEAST OHIO EYE SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-893-9794
Mailing Address - Street 1:915 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-6833
Mailing Address - Country:US
Mailing Address - Phone:330-833-1091
Mailing Address - Fax:330-833-1092
Practice Address - Street 1:915 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6833
Practice Address - Country:US
Practice Address - Phone:330-833-1091
Practice Address - Fax:330-833-1092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST OHIO EYE SURGEONS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty