| |
6828 Market St, Boardman, OH 44512-4503 | |
(330) 629-9870 | |
(330) 629-9791 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 6828 Market St, Boardman, Ohio |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1700078714 | NPI | - | NPPES |
302544644012 | Other | OH | MEDICAL MUTUAL |
2280106 | Medicaid | OH | |
000000139002 | Other | OH | ANTHEM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 3497 / T1403 (Ohio) | Secondary |
332H00000X | Eyewear Supplier | 152W00000X (Ohio) | Primary |
Mailing Address | Practice Location Address |
---|---|
6828 Market St, Boardman, OH 44512-4503 Ph: (330) 629-9870 | 6828 Market St, Boardman, OH 44512-4503 Ph: (330) 629-9870 |