Healthcare Provider Details

I. General information

NPI: 1427237494
Provider Name (Legal Business Name): GREENE COUNTY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
CEDARVILLE OH
45314-9508
US

IV. Provider business mailing address

400 N MAIN ST
CEDARVILLE OH
45314-9508
US

V. Phone/Fax

Practice location:
  • Phone: 937-766-2622
  • Fax: 937-766-7120
Mailing address:
  • Phone: 937-766-2622
  • Fax: 937-766-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5469
License Number StateOH

VIII. Authorized Official

Name: DR. LINDSAY NICCOLE FLORKEY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 937-766-2622