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General NPI Number Information
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NPI Number | 1609076462
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Entity Type | Organization
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Legal Business Name | FEC MOBILE EYE CLINIC, INC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 7200 MENTOR AVE SUITE A
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City | MENTOR
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State | OH
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Zip | 44060-7522
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Country | US
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Telephone | 440-946-8758
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Fax | 440-946-0023
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Provider Business Mailing Address
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Address Line | 7200 MENTOR AVE SUITE A
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City | MENTOR
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State | OH
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Zip | 44060-7522
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Country | US
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Telephone | 440-946-8758
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Fax | 440-946-0023
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN J KANE
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Credential | O.D.
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Telephone | 440-946-8758
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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 |
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License Number State |
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