Provider Demographics
NPI:1134279615
Name:FAMILY EYE CARE GROUP INC
Entity Type:Organization
Organization Name:FAMILY EYE CARE GROUP INC
Other - Org Name:PATTY VISION CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-227-2777
Mailing Address - Street 1:124 W CRESCENT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-4014
Mailing Address - Country:US
Mailing Address - Phone:336-227-2777
Mailing Address - Fax:336-227-9499
Practice Address - Street 1:124 W CRESCENT SQUARE DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-4014
Practice Address - Country:US
Practice Address - Phone:336-227-2777
Practice Address - Fax:336-227-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900546Medicaid
NC5900546Medicaid
2345970Medicare PIN