Provider Demographics
NPI:1043608722
Name:MY FAMILY VISION CLINIC LLC
Entity Type:Organization
Organization Name:MY FAMILY VISION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-345-2954
Mailing Address - Street 1:212 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3515
Mailing Address - Country:US
Mailing Address - Phone:308-345-2954
Mailing Address - Fax:700-345-7719
Practice Address - Street 1:212 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3515
Practice Address - Country:US
Practice Address - Phone:308-345-2954
Practice Address - Fax:700-345-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty