Provider Demographics
NPI:1699945535
Name:C AND G EYECARE LLC
Entity type:Organization
Organization Name:C AND G EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-599-5315
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2371
Mailing Address - Country:US
Mailing Address - Phone:937-599-5315
Mailing Address - Fax:937-599-1185
Practice Address - Street 1:1008 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2371
Practice Address - Country:US
Practice Address - Phone:937-599-5315
Practice Address - Fax:937-599-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3526152WC0802X
OH4696152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0505491OtherPALMETTO GBA
OH0215387Medicaid
OHGA0793641OtherPALMETTO GBA
OH0566105Medicaid
OHP00221595OtherUNITED HEALTHCARE RAILROAD MEDICARE
OHP00221595OtherUNITED HEALTHCARE RAILROAD MEDICARE
OHGA0793641OtherPALMETTO GBA
CO0505491OtherPALMETTO GBA
OH0215387Medicaid
OHGA0793641OtherPALMETTO GBA
T47428Medicare UPIN
CO0505491Medicare PIN