Provider Demographics
NPI:1447374822
Name:DREFFER,HICKS&DEMOS, O.D., INC.
Entity type:Organization
Organization Name:DREFFER,HICKS&DEMOS, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:LINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-433-2630
Mailing Address - Street 1:310 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1648
Mailing Address - Country:US
Mailing Address - Phone:419-433-2630
Mailing Address - Fax:419-433-2285
Practice Address - Street 1:310 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1648
Practice Address - Country:US
Practice Address - Phone:419-433-2630
Practice Address - Fax:419-433-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576860001OtherDME REGION B
OH2980216Medicaid
OH0576860001OtherDME REGION B
OH0576860001Medicare NSC