MEDICARE: ADVANCED FAMILY EYECARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3486T151	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003854266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FAMILY EYECARE, INC.

Provider Business Mailing Address
First Line	:	1355 W MAIN ST
Second Line	:	SUITE A
City	:	BELLEVUE
State	:	OH
Zip	:	44811-9082
Country	:	US
Telephone Number	:	419-483-7685
Fax Number	:	419-483-4694

Provider Business Practice Location Address
First Line	:	1355 W MAIN ST
Second Line	:	SUITE A
City	:	BELLEVUE
State	:	OH
Zip	:	44811-9082
Country	:	US
Telephone Number	:	419-483-7685
Fax Number	:	419-483-4694

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK DAVID PIFER
Credential	:	O.D.
Telephone Number	:	419-483-7685

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	05/05/2009

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