Provider Demographics
NPI:1164595203
Name:QUALITY FAMILY EYECARE, INC
Entity Type:Organization
Organization Name:QUALITY FAMILY EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-666-0700
Mailing Address - Street 1:647 LIME CITY RD
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1444
Mailing Address - Country:US
Mailing Address - Phone:419-666-0700
Mailing Address - Fax:419-666-9605
Practice Address - Street 1:647 LIME CITY RD
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1444
Practice Address - Country:US
Practice Address - Phone:419-666-0700
Practice Address - Fax:419-666-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND038272001OtherADMINISTAR
OH2051416Medicaid
OH2051416Medicaid
OH=========3A12OtherANTHEM
OH9311661Medicare PIN