Provider Demographics
NPI:1902190762
Name:HOLLYWOOD FAMILY EYE CARE INC
Entity Type:Organization
Organization Name:HOLLYWOOD FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STIPANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-440-2318
Mailing Address - Street 1:276 S HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2422
Mailing Address - Country:US
Mailing Address - Phone:330-440-2318
Mailing Address - Fax:
Practice Address - Street 1:276 S HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2422
Practice Address - Country:US
Practice Address - Phone:330-440-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS4846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty