Provider Demographics
NPI:1174568067
Name:FIRELANDS EYECARE CENTER, INC.
Entity type:Organization
Organization Name:FIRELANDS EYECARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:HARPSTER
Authorized Official - Last Name:MAUL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-668-6067
Mailing Address - Street 1:112 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2132
Mailing Address - Country:US
Mailing Address - Phone:419-668-6067
Mailing Address - Fax:419-663-6058
Practice Address - Street 1:112 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2132
Practice Address - Country:US
Practice Address - Phone:419-668-6067
Practice Address - Fax:419-663-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3512T554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479012Medicaid
OH2728043Medicaid
OH0489510Medicaid
OH0552662Medicare PIN
OH0489510Medicaid
OHT48073Medicare UPIN
OH0265130001Medicare NSC
OHT48074Medicare UPIN
OH0552661Medicare ID - Type Unspecified
OH2728043Medicaid
OH4193161Medicare PIN