Healthcare Provider Details

I. General information

NPI: 1396104873
Provider Name (Legal Business Name): FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST
GREENVILLE OH
45331-1401
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-6111
  • Fax:
Mailing address:
  • Phone: 937-548-9680
  • Fax: 937-548-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT.5454.THER
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT.3360-THER
License Number StateOH

VIII. Authorized Official

Name: MRS. JEAN E. YOUNG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-548-3806