Family Eye Care Clinic of Bluffton, LLC
Organization Active NPI Optometrist · Bluffton, OH
NPI 1053500611 · NPPES record last updated Feb 20, 2017
Key facts
- NPI
- 1053500611
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 539 (OH)
- Legal business name
- FAMILY EYE CARE CLINIC OF BLUFFTON, LLC
- Practice address
- 107 N Main St
Bluffton, OH 45817-1245 - Phone
- (419) 358-6076
- Fax
- (419) 358-7736
- NPI assigned
- Oct 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark Alan Yoder, O.D.
- Title
- Owner/Optometrist
- Phone
- (419) 358-6076
Practitioners 2
-
Nathan M Goedde, O.D.
-
Mark Alan Yoder, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2140553 | Family Eye Care Clinic of Bluffton Ohio LLC | Certificate of waiver | Nov 21, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Family Eye Care Clinic of Bluffton |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120626000624 | OH | Part B Supplier - Clinic/Group Practice | 8325203292 |
Receives reassigned benefits from 2 practitioners Practice locations: Bluffton, OH |
| O20120917000728 | OH | DME Supplier - Physician - Optometrist | 8325203292 | Practice locations: Bluffton, OH |
National Provider Directory
Locations
107 N Main St
Bluffton, OH 45817
Phone (419) 358-6076
410 W Elm St
Bluffton, OH 45817
Phone (419) 358-1015
7400 Swaney Rd
Bluffton, OH 45817
Phone (419) 643-3161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 539 | OH | Yes |
Addresses
Primary practice location
107 N Main St
Bluffton, OH 45817-1245
Mailing address
107 N Main St
PO Box 123
Bluffton, OH 45817-1245
Phone (419) 358-6076
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2995997 | Medicaid | OH | |
| 0743664 | Medicaid | OH | |
| DT0332 | Other | OH | RAILROAD MEDICARE |
| 0100488 | Medicaid | OH |
Other providers in Bluffton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.