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General NPI Number Information
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NPI Number | 1174568067
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Entity Type | Organization
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Legal Business Name | FIRELANDS EYECARE CENTER, INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 112 BENEDICT AVE
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City | NORWALK
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State | OH
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Zip | 44857-2132
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Country | US
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Telephone | 419-668-6067
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Fax | 419-663-6058
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Provider Business Mailing Address
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Address Line | 112 BENEDICT AVE
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City | NORWALK
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State | OH
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Zip | 44857-2132
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Country | US
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Telephone | 419-668-6067
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Fax | 419-663-6058
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Authorized Official
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Title or Position | PRES
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Name | DR. PEGGY HARPSTER MAUL
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Credential | O.D.
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Telephone | 419-668-6067
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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 | 3512T554
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License Number State | OH
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