Provider Demographics
NPI:1134477144
Name:FAMILY VISION CARE, LLC
Entity Type:Organization
Organization Name:FAMILY VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONSBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-378-4181
Mailing Address - Street 1:10309 STABLEHAND DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4642
Mailing Address - Country:US
Mailing Address - Phone:215-378-4181
Mailing Address - Fax:
Practice Address - Street 1:11564 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3527
Practice Address - Country:US
Practice Address - Phone:215-378-4181
Practice Address - Fax:513-671-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6025/T2940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12340066OtherCAQH