Eastgate Family Vision, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

5920 Issued in OH

Legal business name

EASTGATE FAMILY VISION, LLC

Practice address

867 Eastgate North Dr
Cincinnati, OH 45245-1791

Phone

(513) 752-4038

NPI assigned

Jun 8, 2017

Organization subpart

No

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

Authorized official

Name

Evan Bayles, OD

Title

Sole Member

Phone

(740) 751-5729

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1548799018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 EASTGATE NORTH DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452451791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 EASTGATE NORTH DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452451791",
            "telephone_number": "513-752-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE FAMILY VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "BAYLES",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "740-751-5729",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; 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.