Provider Demographics
NPI:1235285628
Name:DAYTON EYE SURGERY CENTER L L C
Entity type:Organization
Organization Name:DAYTON EYE SURGERY CENTER L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DON/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISENBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-431-9531
Mailing Address - Street 1:81 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3237
Mailing Address - Country:US
Mailing Address - Phone:937-431-9531
Mailing Address - Fax:937-431-9532
Practice Address - Street 1:81 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3237
Practice Address - Country:US
Practice Address - Phone:937-431-9531
Practice Address - Fax:937-431-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0553AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH490004334OtherMEDICARE RAILROAD
OH6800130OtherUNITED HEALTH CARE
OH2138449Medicaid
OH64394OtherANTHEM BLUE CROSS BLUE SHIELD
OH2138449Medicaid