Provider Demographics
NPI:1639264872
Name:LAKE ERIE FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:LAKE ERIE FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:FELBINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-734-2106
Mailing Address - Street 1:222 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1141
Mailing Address - Country:US
Mailing Address - Phone:419-734-2106
Mailing Address - Fax:419-734-3792
Practice Address - Street 1:222 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1141
Practice Address - Country:US
Practice Address - Phone:419-734-2106
Practice Address - Fax:419-734-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3027/T449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02487OtherPARAMOUNT HEALTH CARE
OH2284611Medicaid
OH300709331004OtherMEDICAL MUTUAL OF OHIO
OH04231OtherPARAMOUNT HEALTH CARE
OH298423149006OtherMEDICAL MUTUAL OF OHIO
OH000000510602OtherANTHEM BCBS
OH000000519919OtherANTHEM BCBS
OH0257181Medicaid
OH2628704Medicaid
OHP00305907Medicare PIN
OH000000510602OtherANTHEM BCBS
OH298423149006OtherMEDICAL MUTUAL OF OHIO
OH2628704Medicaid
OH2284611Medicaid
OH0257181Medicaid
OH000000519919OtherANTHEM BCBS
OHDE6416Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
OH6171920001Medicare NSC