Provider Demographics
NPI:1073674446
Name:FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:THAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-753-5103
Mailing Address - Street 1:335 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1000
Mailing Address - Country:US
Mailing Address - Phone:508-753-5103
Mailing Address - Fax:508-753-6395
Practice Address - Street 1:335 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1000
Practice Address - Country:US
Practice Address - Phone:508-753-5103
Practice Address - Fax:508-753-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9715070Medicaid
4590340001Medicare NSC
MAW21059Medicare ID - Type Unspecified