1396828067 NPI number — SPECTRUM EYE CARE INC

Table of content: (NPI 1396828067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396828067 NPI number — SPECTRUM EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM EYE CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EYE SURGEONS OF FINDLAY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396828067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15840 MEDICAL DRIVE SOUTH
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-422-6190
Provider Business Mailing Address Fax Number:
419-423-3235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15840 MEDICAL DRIVE SOUTH
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-422-6190
Provider Business Practice Location Address Fax Number:
419-423-3235
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSHOT
Authorized Official First Name:
JACK
Authorized Official Middle Name:
G G
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
419-422-6190

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0297021 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF6565 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 487287400 . This is a "DEPT OF LABORWORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 14540000 . This is a "PROXYMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000319582 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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