Provider Demographics
NPI:1255507075
Name:FAMILY EYECARE CENTER, LLC.
Entity Type:Organization
Organization Name:FAMILY EYECARE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-629-1090
Mailing Address - Street 1:21178 OLEAN BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6728
Mailing Address - Country:US
Mailing Address - Phone:941-629-1090
Mailing Address - Fax:
Practice Address - Street 1:21178 OLEAN BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6728
Practice Address - Country:US
Practice Address - Phone:941-629-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
FLOS10225207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty