Provider Demographics
NPI:1063534329
Name:EYECARE SERVICES INC
Entity type:Organization
Organization Name:EYECARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-636-1531
Mailing Address - Street 1:1313 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1545
Mailing Address - Country:US
Mailing Address - Phone:419-636-1531
Mailing Address - Fax:
Practice Address - Street 1:1313 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1545
Practice Address - Country:US
Practice Address - Phone:419-636-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0355431Medicaid
OH2740583Medicaid
OH0118287Medicaid
OH2374452Medicaid
OH0886251Medicaid
OH2751660Medicaid
OH1063534329Medicare NSC
OH0864952Medicare PIN
OH1320640001Medicare NSC
OH0798232Medicare PIN
OH0723573Medicare PIN
OH410046113Medicare PIN
OH410046114Medicare PIN
OH2751660Medicaid
OH410046115Medicare PIN
OH0431873Medicare PIN