Provider Demographics
NPI:1184664120
Name:FELTZ AND MCCLOY, LLC
Entity Type:Organization
Organization Name:FELTZ AND MCCLOY, LLC
Other - Org Name:PROFESSIONAL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-387-6633
Mailing Address - Street 1:1723 MARION-MT. GILEAD RD.
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7842
Mailing Address - Country:US
Mailing Address - Phone:740-387-6880
Mailing Address - Fax:740-387-7443
Practice Address - Street 1:1723 MARION-MT. GILEAD RD.
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7842
Practice Address - Country:US
Practice Address - Phone:740-387-6880
Practice Address - Fax:740-387-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4642T1417152W00000X, 152WV0400X
OH5472T2384152W00000X, 152WV0400X
OH4665T1440152W00000X, 152WV0400X
152W00000X, 332H00000X
OH5572T2486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7784332OtherAETNA
OH2687230Medicaid
OHDB2387OtherRAILROAD MEDICARE
OHDB2387OtherRAILROAD MEDICARE
OH7784332OtherAETNA
OH2687230Medicaid
OH2687230Medicaid
OH9320691Medicare PIN
OH=========OtherANTHEM