Provider Demographics
NPI:1396828067
Name:SPECTRUM EYE CARE INC
Entity Type:Organization
Organization Name:SPECTRUM EYE CARE INC
Other - Org Name:EYE SURGEONS OF FINDLAY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G G
Authorized Official - Last Name:HENDERSHOT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:419-422-6190
Mailing Address - Street 1:15840 MEDICAL DRIVE SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840
Mailing Address - Country:US
Mailing Address - Phone:419-422-6190
Mailing Address - Fax:419-423-3235
Practice Address - Street 1:15840 MEDICAL DRIVE SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-422-6190
Practice Address - Fax:419-423-3235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM EYE CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0297021Medicaid
OHCF6565OtherRR MEDICARE
OH487287400OtherDEPT OF LABORWORKERS COMP
OH14540000OtherPROXYMED
OH000000319582OtherANTHEM BCBS
OH487287400OtherDEPT OF LABORWORKERS COMP
OH0297021Medicaid