Provider Demographics
NPI:1598056319
Name:HICKSVILLE FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:HICKSVILLE FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOCKEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-542-7741
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1120
Mailing Address - Country:US
Mailing Address - Phone:419-542-7741
Mailing Address - Fax:419-542-7742
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1120
Practice Address - Country:US
Practice Address - Phone:419-542-7741
Practice Address - Fax:419-542-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6005T2920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9395161Medicare PIN