MEDICARE: DREFFER,HICKS&DEMOS, O.D., 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	2728	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0576860001	OTHER	OH	DME REGION B
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447374822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREFFER,HICKS&DEMOS, O.D., INC.

Provider Business Mailing Address
First Line	:	310 WILLIAMS ST
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1648
Country	:	US
Telephone Number	:	419-433-2630
Fax Number	:	419-433-2285

Provider Business Practice Location Address
First Line	:	310 WILLIAMS ST
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1648
Country	:	US
Telephone Number	:	419-433-2630
Fax Number	:	419-433-2285

Authorized Official
Title or Position	:	FRONT DESK ADMINISTRATOR
Name	:	MRS. CARON S LINDSLEY
Credential	:
Telephone Number	:	419-433-2630

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/02/2010

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