Provider Demographics
NPI:1851535652
Name:AUGLAIZE FAMILY EYE CARE INC
Entity Type:Organization
Organization Name:AUGLAIZE FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-738-2715
Mailing Address - Street 1:1201 DEFIANCE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1086
Mailing Address - Country:US
Mailing Address - Phone:419-738-2715
Mailing Address - Fax:419-738-2815
Practice Address - Street 1:1201 DEFIANCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1086
Practice Address - Country:US
Practice Address - Phone:419-738-2715
Practice Address - Fax:419-738-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5062 T1939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2983580Medicaid
OH104689500-00OtherBWC
OH6138OtherPARAMOUNT HEALTH CARE
OH000000617762OtherANTHEM BCBS
OH2983580Medicaid
OH104689500-00OtherBWC
OH6307560001Medicare NSC