Provider Demographics
NPI:1366622060
Name:CARDINAL FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:CARDINAL FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-888-5058
Mailing Address - Street 1:885 HIGH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4158
Mailing Address - Country:US
Mailing Address - Phone:614-888-5058
Mailing Address - Fax:614-888-0679
Practice Address - Street 1:885 HIGH ST
Practice Address - Street 2:STE 102
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4158
Practice Address - Country:US
Practice Address - Phone:614-888-5058
Practice Address - Fax:614-888-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5409240001Medicare NSC
9346731Medicare PIN