Provider Demographics
NPI:1962065672
Name:SUMMIT FAMILY VISION LLC
Entity type:Organization
Organization Name:SUMMIT FAMILY VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HULTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-697-4748
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5880
Mailing Address - Country:US
Mailing Address - Phone:330-697-4748
Mailing Address - Fax:866-425-2239
Practice Address - Street 1:3265 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3337
Practice Address - Country:US
Practice Address - Phone:330-836-2200
Practice Address - Fax:866-425-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty