Provider Demographics
NPI:1255460838
Name:DR. ERIC'S TOTAL VISION CARE
Entity type:Organization
Organization Name:DR. ERIC'S TOTAL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD LICENSED OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-891-8338
Mailing Address - Street 1:431 W BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1351
Mailing Address - Country:US
Mailing Address - Phone:440-891-8338
Mailing Address - Fax:440-891-8959
Practice Address - Street 1:431 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1351
Practice Address - Country:US
Practice Address - Phone:440-891-8338
Practice Address - Fax:440-891-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3856 T053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH135027OtherANTHEM BC BS
OH9250461Medicare ID - Type UnspecifiedGROUP PROVIDER
OH0597901Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO.