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General NPI Number Information
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NPI Number | 1205157393
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Entity Type | Organization
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Legal Business Name | SUNBURY FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 06/12/2010
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Last Update Date | 06/12/2010
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Provider Practice Location Address
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Address Line | 257 W GRANVILLE ST SUITE 100
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City | SUNBURY
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State | OH
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Zip | 43074-9684
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Country | US
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Telephone | 740-965-1165
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Fax | 740-965-1176
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Provider Business Mailing Address
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Address Line | 257 W GRANVILLE ST SUITE 100 /P.O.BOX 300
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City | SUNBURY
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State | OH
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Zip | 43074-9684
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Country | US
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Telephone | 740-965-1165
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Fax | 740-965-1176
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DEBORAH L WRIGHT
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Credential | O.D.
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Telephone | 740-965-1165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4876/T1590
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License Number State | OH
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