# SOUTHERN OHIO EYE SURGICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447286059
- **Authorized official:** DR. STEPHEN EDWARD DEMICK MD (OWNER)
- **Authorized official phone:** (740) 773-6347

## Contact information

- **Practice address:** 159 E 2ND ST, CHILLICOTHE, OH 45601-2526
- **Practice address phone:** (740) 773-6347
- **Practice address fax:** (740) 773-9093
- **Mailing address:** 159 E 2ND ST, CHILLICOTHE, OH 45601-2526
- **Mailing address phone:** (740) 773-6347
- **Mailing address fax:** (740) 773-9093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 4930 | OH | — |
| 207W00000X | Ophthalmology Physician | 22313 | WV | — |
| 207W00000X | Ophthalmology Physician | 35059420D | OH | Yes |
| 207W00000X | Ophthalmology Physician | 35078998E | OH | — |
| 207W00000X | Ophthalmology Physician | — | NULL | — |
| 207W00000X | Ophthalmology Physician | — | — | — |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 02/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2383951 | — | OH |
| 05 | — | 2383988 | — | OH |
| 05 | — | 2544367 | — | OH |
| 01 | — | 5257400001 | MEDICARE DME MAC | OH |