Provider Demographics
NPI:1023068228
Name:ATHENS EYE CARE, LLC
Entity type:Organization
Organization Name:ATHENS EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-594-2271
Mailing Address - Street 1:14 UNIVERSITY ESTATES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-594-2271
Mailing Address - Fax:740-594-2270
Practice Address - Street 1:14 UNIVERSITY ESTATES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3375
Practice Address - Country:US
Practice Address - Phone:740-594-2271
Practice Address - Fax:740-594-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3628152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104738Medicaid
OHV01932Medicare UPIN
OHT47739Medicare UPIN
OH9277461Medicare PIN
OHT47577Medicare UPIN
OH0224590001Medicare NSC