=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528182060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREFFER, HICKS, & DEMOS OD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 03/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2331 COLUMBUS AVE
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-626-0272
-----------------------------------------------------
Fax | 419-626-1546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2331 COLUMBUS AVE
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-626-0272
-----------------------------------------------------
Fax | 419-626-1546
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FRONT DESK ADMINISTRATOR
-----------------------------------------------------
Name | CATHY CUTCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-626-0272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------