Provider Demographics
NPI:1306044516
Name:KENTON FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:KENTON FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:W
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-673-5201
Mailing Address - Street 1:315 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1575
Mailing Address - Country:US
Mailing Address - Phone:419-673-5201
Mailing Address - Fax:419-673-8652
Practice Address - Street 1:315 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1575
Practice Address - Country:US
Practice Address - Phone:419-673-5201
Practice Address - Fax:419-673-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251790Medicaid
OH0197100001Medicare NSC
OH9272281Medicare PIN
OHDD6270Medicare PIN