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General NPI Number Information
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NPI Number | 1225238710
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Entity Type | Organization
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Legal Business Name | CUSTOMEYES FAMILY OPTOMETRY INC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 1611 TIKI LN
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City | LANCASTER
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State | OH
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Zip | 43130-8729
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Country | US
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Telephone | 740-687-1555
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Fax | 740-687-1691
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Provider Business Mailing Address
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Address Line | 1611 TIKI LN
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City | LANCASTER
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State | OH
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Zip | 43130-8729
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Country | US
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Telephone | 740-687-1555
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Fax | 740-687-1691
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. AARON WARD BOWMAN
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Credential | O.D.
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Telephone | 740-687-1555
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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 | 5374
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License Number State | OH
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