Provider Demographics
NPI:1609076462
Name:FEC MOBILE EYE CLINIC, INC
Entity Type:Organization
Organization Name:FEC MOBILE EYE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-946-8758
Mailing Address - Street 1:7200 MENTOR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7522
Mailing Address - Country:US
Mailing Address - Phone:440-946-8758
Mailing Address - Fax:440-946-0023
Practice Address - Street 1:7200 MENTOR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7522
Practice Address - Country:US
Practice Address - Phone:440-946-8758
Practice Address - Fax:440-946-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2312812Medicaid
OH9320421Medicare PIN
OH2312812Medicaid
OH4392610001Medicare NSC