Provider Demographics
NPI:1922192061
Name:DRS. FAVEDE & ASSOCIATES
Entity Type:Organization
Organization Name:DRS. FAVEDE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FAVEDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-635-0814
Mailing Address - Street 1:100 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1605
Mailing Address - Country:US
Mailing Address - Phone:740-635-0814
Mailing Address - Fax:740-635-2521
Practice Address - Street 1:100 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1605
Practice Address - Country:US
Practice Address - Phone:740-635-0814
Practice Address - Fax:740-635-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9275851Medicare PIN
0205220001Medicare NSC