Provider Demographics
NPI:1235293440
Name:FAMILY EYE CARE PROFESSIONALS, INC
Entity Type:Organization
Organization Name:FAMILY EYE CARE PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:GRIMM
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-773-8055
Mailing Address - Street 1:77 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3104
Mailing Address - Country:US
Mailing Address - Phone:740-773-8055
Mailing Address - Fax:740-773-8057
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-773-8055
Practice Address - Fax:740-773-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251156Medicaid
OH2251165Medicaid
OH9308672Medicare PIN
OHCG3520Medicare PIN
OH2251156Medicaid
OH9308671Medicare PIN
OHCG3521Medicare PIN