Provider Demographics
NPI:1023557998
Name:PROFESSIONAL EYE CARE OF TUSCARAWAS COUNTY LLC
Entity Type:Organization
Organization Name:PROFESSIONAL EYE CARE OF TUSCARAWAS COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAMBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-343-8863
Mailing Address - Street 1:217 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2611
Mailing Address - Country:US
Mailing Address - Phone:330-343-8863
Mailing Address - Fax:330-343-3590
Practice Address - Street 1:217 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2611
Practice Address - Country:US
Practice Address - Phone:330-343-8863
Practice Address - Fax:330-343-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty