Provider Demographics
NPI:1902001548
Name:THE FAMILY EYE CARE CENTER
Entity Type:Organization
Organization Name:THE FAMILY EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-621-1822
Mailing Address - Street 1:2626 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3415
Mailing Address - Country:US
Mailing Address - Phone:216-621-1822
Mailing Address - Fax:216-621-1820
Practice Address - Street 1:2626 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3415
Practice Address - Country:US
Practice Address - Phone:216-621-1822
Practice Address - Fax:216-621-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2773 T677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5985331Medicaid
OH1609942424OtherSELF
OH1609942424OtherSELF
OH5985331Medicaid