Provider Demographics
NPI:1528182060
Name:DREFFER, HICKS, & DEMOS OD INC
Entity Type:Organization
Organization Name:DREFFER, HICKS, & DEMOS OD INC
Other - Org Name:FAMILY EYE CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT DESK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-0272
Mailing Address - Street 1:2331 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4827
Mailing Address - Country:US
Mailing Address - Phone:419-626-0272
Mailing Address - Fax:419-626-1546
Practice Address - Street 1:2331 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4827
Practice Address - Country:US
Practice Address - Phone:419-626-0272
Practice Address - Fax:419-626-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744212Medicaid
OH0576860002OtherDME REGION B
OH2744212Medicaid
OH0576860002OtherDME REGION B