Provider Demographics
NPI:1548312093
Name:EYE - TECH OPT INC
Entity type:Organization
Organization Name:EYE - TECH OPT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:DESALVO
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN DO
Authorized Official - Phone:513-421-2911
Mailing Address - Street 1:645 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202
Mailing Address - Country:US
Mailing Address - Phone:513-421-2911
Mailing Address - Fax:513-421-4416
Practice Address - Street 1:2057 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-233-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC4729156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374812Medicaid