Organization Name: | SUNBURY FAMILY EYECARE, LLC |
NPI Number: | 1205157393 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBORAH L WRIGHT (MEMBER) |
Mailing Address: | 257 W Granville St Suite 100 Sunbury |
State: | OH US |
Postal Code: | 430749684 |
Phone Number: | 7409651165 |
Fax Number: | 7409651176 |
NPI Enumeration Date: | 06/12/2010 |
NPI Last Update Date: | 06/12/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | 4876/T1590 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |