Provider Demographics
NPI:1003854266
Name:ADVANCED FAMILY EYECARE, INC.
Entity Type:Organization
Organization Name:ADVANCED FAMILY EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PIFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-483-7685
Mailing Address - Street 1:1355 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9082
Mailing Address - Country:US
Mailing Address - Phone:419-483-7685
Mailing Address - Fax:419-483-4694
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9082
Practice Address - Country:US
Practice Address - Phone:419-483-7685
Practice Address - Fax:419-483-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3486T151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664688Medicaid
OHT47417Medicare UPIN
OH0664688Medicaid
OH0409930001Medicare NSC
OH4040581Medicare PIN