Eyes on Stark Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EYES ON STARK SURGERY CENTER, LLC

Doing business as

Vista Surgical Center

Practice address

4319 Executive Circle NW
Canton, OH 44718

Phone

(330) 526-0530

Fax

(330) 526-0531

NPI assigned

Jul 10, 2012

Last updated

Feb 8, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5954

Specialties & licenses 1

Addresses

Other names 1

• Vista Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

Vista Surgical CenterCCN 36C0001278

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Ohiohealth Corporation

  dba Doctors Hospital

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1972535052

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1023373628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4319 EXECUTIVE CIR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182999",
            "telephone_number": "330-526-0530",
            "fax_number": "330-526-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4319 EXECUTIVE CIRCLE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44718",
            "telephone_number": "330-526-0530",
            "fax_number": "330-526-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYES ON STARK SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vista Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isiaha Everette
• Excellence Expected Home Health Services LLC
• Expanding Hearts LLC
• Eye Centers of Ohio, Inc
• Eye Surgical Center, LLC (The Institute for Refractive and Intraocular Surgery)
• Erik Eyring, CRNA
• Carlos E. Fabre, M.D.
• Katherine Facaros, D.P.M
• Thameenah Z Faheem
• Daniel C Fahl

• Ambulatory Surgical Clinic/Center in Canton, OH
• Providers in Canton, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.