Provider Demographics
NPI:1003675893
Name:FAMILY FIRST VISION CARE GEORGIA PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST VISION CARE GEORGIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DRESAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-757-3225
Mailing Address - Street 1:PO BOX 631665
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1665
Mailing Address - Country:US
Mailing Address - Phone:817-757-3225
Mailing Address - Fax:
Practice Address - Street 1:1455 RIVERSTONE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5627
Practice Address - Country:US
Practice Address - Phone:770-479-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty