Provider Demographics
NPI:1043330871
Name:DREFFER, HICKS, & DEMOS O.D. INC.
Entity Type:Organization
Organization Name:DREFFER, HICKS, & DEMOS O.D. INC.
Other - Org Name:FAMILY EYE CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMOTRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-547-9126
Mailing Address - Street 1:1074 WEST MCPHERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410
Mailing Address - Country:US
Mailing Address - Phone:419-547-9126
Mailing Address - Fax:419-547-0387
Practice Address - Street 1:1074 WEST MCPHERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410
Practice Address - Country:US
Practice Address - Phone:419-547-9126
Practice Address - Fax:419-547-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2276059Medicaid
OH2276059Medicaid
0576860003Medicare NSC
OH9292043Medicare PIN
OHDE0886033Medicare ID - Type Unspecified
OHCG0387Medicare PIN