Provider Demographics
NPI:1770794406
Name:EYECARE OPTIQUES, INC
Entity type:Organization
Organization Name:EYECARE OPTIQUES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-562-3822
Mailing Address - Street 1:905 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2663
Mailing Address - Country:US
Mailing Address - Phone:419-562-3822
Mailing Address - Fax:419-562-9939
Practice Address - Street 1:905 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2663
Practice Address - Country:US
Practice Address - Phone:419-562-3822
Practice Address - Fax:419-562-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090299Medicaid
OH0850100Medicaid
OH289381442-00OtherBWC (DR. COLLIER)
OH289381442-002OtherMEDICAL MUTUAL (DR. COLLI
OH0005482194OtherAETNA (GROUP)
OHEO14678OtherSPECTERA (GROUP)
OH0005635655OtherAETNA (DR. COLLIER)
OHOH2786OtherEYEMED (DR. COLLIER)
OH000000127556OtherANTHEM
OH2400860Medicaid
OH0850100Medicaid
OHEO14678OtherSPECTERA (GROUP)
OH9273611Medicare ID - Type UnspecifiedGROUP ID
OH0480040001Medicare NSC
OHCF6567Medicare PIN
OH0005482194OtherAETNA (GROUP)
OH0090299Medicaid