Provider Demographics
NPI:1053532994
Name:OPTOMETRIC CARE INC
Entity type:Organization
Organization Name:OPTOMETRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:CORNELL
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-385-4017
Mailing Address - Street 1:498 W HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1105
Mailing Address - Country:US
Mailing Address - Phone:740-385-4017
Mailing Address - Fax:740-385-7666
Practice Address - Street 1:498 W HUNTER ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1105
Practice Address - Country:US
Practice Address - Phone:740-385-4017
Practice Address - Fax:740-385-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3079305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0322976Medicaid
OH0322976Medicaid
OH0524800001Medicare NSC
OH9274701Medicare PIN