Provider Demographics
NPI:1497884050
Name:GREENE COUNTY EYE CARE, INC.
Entity Type:Organization
Organization Name:GREENE COUNTY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:NICCOLE
Authorized Official - Last Name:FLORKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-376-4055
Mailing Address - Street 1:322 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2233
Mailing Address - Country:US
Mailing Address - Phone:937-376-4055
Mailing Address - Fax:937-376-3969
Practice Address - Street 1:322 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2233
Practice Address - Country:US
Practice Address - Phone:937-376-4055
Practice Address - Fax:937-376-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630531Medicaid
OH2630531Medicaid
OH5966140001Medicare NSC