Provider Demographics
NPI:1225392319
Name:TALLMADGE FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:TALLMADGE FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-630-2580
Mailing Address - Street 1:137 EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2339
Mailing Address - Country:US
Mailing Address - Phone:330-630-2580
Mailing Address - Fax:234-542-1332
Practice Address - Street 1:137 EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2339
Practice Address - Country:US
Practice Address - Phone:330-630-2580
Practice Address - Fax:234-542-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4830-T1695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty