Ahlquist Eye Care Professionals, LLC.
Organization Active NPI Optometrist · Canfield, OH
NPI 1104000520 · NPPES record last updated Feb 25, 2020
Key facts
- NPI
- 1104000520
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 5455 (OH)
- Legal business name
- AHLQUIST EYE CARE PROFESSIONALS, LLC.
- Practice address
- 45 Manor Hill Dr Ste 100
Canfield, OH 44406-1538 - Phone
- (330) 702-3937
- Fax
- (330) 702-1911
- NPI assigned
- Dec 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Betsy K Ahlquist, O.D.
- Title
- Ceo
- Phone
- (330) 702-3937
Practitioners 2
-
Betsy Kay Ahlquist, O.D.
-
Tiffany Marie Kubis, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100310000438 | OH | Part B Supplier - Clinic/Group Practice | 9436175718 |
Receives reassigned benefits from 2 practitioners Practice locations: Canfield, OH |
National Provider Directory
Locations
45 Manor Hill Dr
Ste 100
Canfield, OH 44406
Phone (330) 702-3931
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 5455 | OH | Yes |
Addresses
Primary practice location
45 Manor Hill Dr Ste 100
Canfield, OH 44406-1538
Mailing address
45 Manor Hill Dr Ste 100
Canfield, OH 44406-1538
Phone (330) 702-3937
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE8432 | Other | OH | MEDICARE RAILROAD |
Other providers in Canfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.