Provider Demographics
NPI:1609022755
Name:FALLEN TIMBERS FAMILY EYE CARE
Entity Type:Organization
Organization Name:FALLEN TIMBERS FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEERJA
Authorized Official - Middle Name:
Authorized Official - Last Name:JINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-878-2628
Mailing Address - Street 1:3100 MAIN ST
Mailing Address - Street 2:SUITE #723
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9867
Mailing Address - Country:US
Mailing Address - Phone:419-878-2628
Mailing Address - Fax:419-878-2546
Practice Address - Street 1:3100 MAIN ST
Practice Address - Street 2:SUITE #723
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9867
Practice Address - Country:US
Practice Address - Phone:419-878-2628
Practice Address - Fax:419-878-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty