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General NPI Number Information
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NPI Number | 1104076959
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Entity Type | Organization
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Legal Business Name | OPTIQUE FAMILY VISION CARE
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 109 S MAIN ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-2274
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Country | US
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Telephone | 740-335-6305
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Fax | 740-335-1025
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Provider Business Mailing Address
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Address Line | 109 S MAIN ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-2274
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Country | US
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Telephone | 740-335-6305
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Fax | 740-335-1025
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREY L ECKERT
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Credential | OD
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Telephone | 740-335-6305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3531
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License Number State | OH
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