Provider Demographics
NPI:1437360153
Name:ATHENS OPTICAL INC.
Entity Type:Organization
Organization Name:ATHENS OPTICAL INC.
Other - Org Name:PROCARE VISION 20
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-592-3937
Mailing Address - Street 1:525 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3758
Mailing Address - Country:US
Mailing Address - Phone:740-592-3937
Mailing Address - Fax:740-592-3934
Practice Address - Street 1:525 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3758
Practice Address - Country:US
Practice Address - Phone:740-592-3937
Practice Address - Fax:740-592-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000292045OtherBCBS
OH7405923937OtherEYEFINITY
OH279349912OtherAETNA
OH279349912OtherMEDICAL MUTUAL
OHSC5357OtherEYEMED
OHSC5357OtherEYEMED
OH0672660001Medicare NSC