Provider Demographics
NPI:1275678286
Name:FAMILY VISION CENTER, INC
Entity Type:Organization
Organization Name:FAMILY VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PIELAET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-686-1237
Mailing Address - Street 1:1471 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4009
Mailing Address - Country:US
Mailing Address - Phone:541-686-1237
Mailing Address - Fax:541-484-2026
Practice Address - Street 1:1471 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4009
Practice Address - Country:US
Practice Address - Phone:541-686-1237
Practice Address - Fax:541-484-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1192ATI152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1039610001Medicare NSC
ORR0000WCJTVMedicare PIN