Provider Demographics
NPI:1205156031
Name:SUMMIT FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:SUMMIT FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-726-1541
Mailing Address - Street 1:5198 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2748
Mailing Address - Country:US
Mailing Address - Phone:419-726-1541
Mailing Address - Fax:419-726-7222
Practice Address - Street 1:5198 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2748
Practice Address - Country:US
Practice Address - Phone:419-726-1541
Practice Address - Fax:419-726-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVO2331Medicare UPIN
OH6472000001Medicare NSC
OHDQ6947Medicare PIN
OH9390061Medicare PIN