=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326213877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCFADYEN FAMILY EYECARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2008
-----------------------------------------------------
Last Update Date | 02/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4424 AICHOLTZ RD STE H
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45245-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-752-2100
-----------------------------------------------------
Fax | 513-752-4300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4424 AICHOLTZ RD STE H
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45245-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-752-2100
-----------------------------------------------------
Fax | 513-752-4300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARISA MCFADYEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 513-752-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4997
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------