Provider Demographics
NPI:1003976622
Name:VISIONQUEST EYECARE
Entity Type:Organization
Organization Name:VISIONQUEST EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:F.
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PERZY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-225-1254
Mailing Address - Street 1:4014 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-225-1254
Mailing Address - Fax:330-225-2033
Practice Address - Street 1:4014 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-225-1254
Practice Address - Fax:330-225-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9336841Medicare PIN