Provider Demographics
NPI:1528152865
Name:FAMILY EYE CARE OF WOOSTER LLC
Entity type:Organization
Organization Name:FAMILY EYE CARE OF WOOSTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAUFFENBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-262-0028
Mailing Address - Street 1:961 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4105
Mailing Address - Country:US
Mailing Address - Phone:330-262-0028
Mailing Address - Fax:330-262-2808
Practice Address - Street 1:961 DOVER RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4105
Practice Address - Country:US
Practice Address - Phone:330-262-0028
Practice Address - Fax:330-262-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2572354Medicaid
OHFA9352531Medicare ID - Type Unspecified
OH5787100001Medicare NSC