Healthcare Provider Details

I. General information

NPI: 1952368250
Provider Name (Legal Business Name): KEARFOTT EYE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S BURNETT RD
SPRINGFIELD OH
45505-1489
US

IV. Provider business mailing address

20 SOUTH BURNETT ROAD
SPRINGFIELD OH
45505-1489
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-6363
  • Fax: 937-325-7262
Mailing address:
  • Phone: 973-325-6363
  • Fax: 937-325-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35055570K
License Number StateOH

VIII. Authorized Official

Name: JEFFREY L KEARFOTT
Title or Position: OWNER
Credential: MD
Phone: 937-325-6363