=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144562752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYEDEALVISIONCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3893 MEDINA RD.
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-666-0191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7640 HOLYOKE AVE.
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-697-4748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD E. HULTS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 330-697-4748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3420
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------