Provider Demographics
NPI:1275103731
Name:NORTHEAST FAMILY EYECARE, LLC
Entity Type:Organization
Organization Name:NORTHEAST FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-482-9514
Mailing Address - Street 1:2821 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4732
Mailing Address - Country:US
Mailing Address - Phone:260-482-9514
Mailing Address - Fax:260-203-5391
Practice Address - Street 1:2821 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4732
Practice Address - Country:US
Practice Address - Phone:260-482-9514
Practice Address - Fax:260-203-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty