Provider Demographics
NPI:1457693616
Name:FOX OPTOMETRY, LLC
Entity Type:Organization
Organization Name:FOX OPTOMETRY, LLC
Other - Org Name:FAMILY VISION & EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:614-787-6700
Mailing Address - Street 1:315 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2001
Mailing Address - Country:US
Mailing Address - Phone:937-592-9777
Mailing Address - Fax:937-592-4060
Practice Address - Street 1:315 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2001
Practice Address - Country:US
Practice Address - Phone:937-592-9777
Practice Address - Fax:937-592-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082225Medicaid
OHH193190Medicare PIN