Northside Optical LLC

Primary specialty

OpticianTaxonomy code 156FX1800X

License

SC2262 Issued in OH

Legal business name

NORTHSIDE OPTICAL LLC

Practice address

140 North Barron St
Eaton, OH 45320

Phone

(937) 472-3937

Fax

(937) 472-3937

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Peggy Lou Barker, LICENSED OPTICIAN

Title

Licensed Optician

Phone

(937) 472-3366

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Designer Eyewear Outlet Doing business as

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306061379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 NORTH BARRON ST",
            "city": "EATON",
            "state": "OH",
            "postal_code": "45320",
            "telephone_number": "937-472-3937",
            "fax_number": "937-472-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NORTH BARRON ST",
            "city": "EATON",
            "state": "OH",
            "postal_code": "45320",
            "telephone_number": "937-472-3937",
            "fax_number": "937-472-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "LOU",
        "authorized_official_title_or_position": "LICENSED OPTICIAN",
        "authorized_official_telephone_number": "937-472-3366",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSED OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "OH",
            "license": "SC2262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2618359",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Designer Eyewear Outlet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optician in Eaton, OH
• Providers in Eaton, OH by specialty
• Optician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.