Provider Demographics
NPI:1548230410
Name:OPHTHALMIC HOLDINGS INC
Entity Type:Organization
Organization Name:OPHTHALMIC HOLDINGS INC
Other - Org Name:FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-722-1270
Mailing Address - Street 1:114 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1458
Mailing Address - Country:US
Mailing Address - Phone:712-737-4246
Mailing Address - Fax:712-707-9855
Practice Address - Street 1:114 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-9999
Practice Address - Country:US
Practice Address - Phone:712-737-4246
Practice Address - Fax:712-707-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0436246Medicaid
IA4907470001Medicare NSC
IA0436246Medicaid
IAI9408Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER