| |
300 Countryside Dr Lebanon OH 45036-7865 | |
(937) 681-4956 | |
(513) 791-2938 |
Full Name | |
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Speciality | Eyewear Supplier |
Location | 300 Countryside Dr, Lebanon, Ohio |
Authorized Official Name and Position | Daniel Harris (OWNER/DIRECTOR) |
Authorized Official Contact | 5137912283 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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300 Countryside Dr Lebanon OH 45036-7865 Ph: (937) 681-4956 | 300 Countryside Dr Lebanon OH 45036-7865 Ph: (937) 681-4956 |
NPI Number | 1710155031 |
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Provider Enumeration Date | 02/20/2008 |
Last Update Date | 03/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710155031 | NPI | - | NPPES |
0896679 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 4286 (Ohio) | Secondary |
332H00000X | Eyewear Supplier | 4286 (Ohio) | Primary |
Broadway Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1470 N Broadway St, Suite100, Lebanon, OH 45036 Phone: 513-932-1936 Fax: 513-932-3105 | |
Trihealth Physician Practices, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Arrow Springs Blvd, Suite 2800, Lebanon, OH 45036 Phone: 513-282-7300 Fax: 513-282-7310 | |
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