Provider Demographics
NPI:1104209188
Name:FAMILY EYE CARE CENTER
Entity Type:Organization
Organization Name:FAMILY EYE CARE CENTER
Other - Org Name:CHILD AND FAMILY EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-363-2980
Mailing Address - Street 1:981 S MAIN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6055
Mailing Address - Country:US
Mailing Address - Phone:435-363-2980
Mailing Address - Fax:435-514-0075
Practice Address - Street 1:981 S MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6055
Practice Address - Country:US
Practice Address - Phone:435-363-2980
Practice Address - Fax:435-514-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9413616-9934261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center