Provider Demographics
NPI:1083869614
Name:FAMILY VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAMILY VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-933-6020
Mailing Address - Street 1:400 S TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1726
Mailing Address - Country:US
Mailing Address - Phone:636-933-6020
Mailing Address - Fax:636-933-6420
Practice Address - Street 1:400 S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1726
Practice Address - Country:US
Practice Address - Phone:636-933-6020
Practice Address - Fax:636-933-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3244332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5114780001Medicare NSC