MEDICARE: SOUTHWEST EYECARE, LLC

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		OH

General Provider Information

NPI Number	:	1790888972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST EYECARE, LLC

Provider Business Mailing Address
First Line	:	4140 HOOVER RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3625
Country	:	US
Telephone Number	:	614-801-2020
Fax Number	:	614-801-0001

Provider Business Practice Location Address
First Line	:	4140 HOOVER RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3625
Country	:	US
Telephone Number	:	614-801-2020
Fax Number	:	614-801-0001

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIE E. SCHIFF
Credential	:	O.D.
Telephone Number	:	614-801-2020

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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