Provider Demographics
NPI:1841472883
Name:PRICE FAMILY EYECARE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:PRICE FAMILY EYECARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-654-4762
Mailing Address - Street 1:135 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2506
Mailing Address - Country:US
Mailing Address - Phone:740-654-4762
Mailing Address - Fax:740-653-7629
Practice Address - Street 1:135 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2506
Practice Address - Country:US
Practice Address - Phone:740-654-4762
Practice Address - Fax:740-653-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2823467Medicaid
OHDG9580Medicare PIN
OH6038580001Medicare NSC
OH2823467Medicaid