Organization
NORTHSIDE OPTICAL LLC
Active
Other names
Designer Eyewear Outlet
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PEGGY LOU BARKER LICENSED OPTICIAN (LICENSED OPTICIAN)
(937) 472-3366
Entity
Organization
Contact information
Practice address
140 NORTH BARRON ST, EATON, OH 45320
(937) 472-3937
(937) 472-3937
Mailing address
140 NORTH BARRON ST, EATON, OH 45320
(937) 472-3937
(937) 472-3937
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SC2262
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2618359
—
OH
Enumeration date
04/16/2007
Last updated
08/22/2020
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