Provider Demographics
NPI:1043291966
Name:PROFESSIONAL EYE CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL EYE CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-461-1885
Mailing Address - Street 1:553 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4856
Mailing Address - Country:US
Mailing Address - Phone:614-461-1885
Mailing Address - Fax:614-461-5730
Practice Address - Street 1:553 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4856
Practice Address - Country:US
Practice Address - Phone:614-461-1885
Practice Address - Fax:614-461-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4245430001Medicare NSC
OHPR9297781Medicare ID - Type Unspecified