Provider Demographics
NPI:1568646107
Name:CAMBRIDGE FAMILY EYE CARE INC
Entity type:Organization
Organization Name:CAMBRIDGE FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-439-1098
Mailing Address - Street 1:1335 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3015
Mailing Address - Country:US
Mailing Address - Phone:740-439-1098
Mailing Address - Fax:740-439-3165
Practice Address - Street 1:1335 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3015
Practice Address - Country:US
Practice Address - Phone:740-439-1098
Practice Address - Fax:740-439-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3120/T800152W00000X
OH4641/T1416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6566685Medicaid
OHCK6110Medicare PIN
OH6566685Medicaid
OH4520820001Medicare NSC