Provider Demographics
NPI:1750438172
Name:CENTERVILLE FAMILY EYE CARE
Entity type:Organization
Organization Name:CENTERVILLE FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-435-8605
Mailing Address - Street 1:125 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5915
Mailing Address - Country:US
Mailing Address - Phone:937-435-8605
Mailing Address - Fax:937-435-6801
Practice Address - Street 1:125 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-5915
Practice Address - Country:US
Practice Address - Phone:937-435-8605
Practice Address - Fax:937-435-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5437570001Medicare NSC
CE9354061Medicare PIN