Provider Demographics
NPI:1295865541
Name:FAMILY VISION CARE OF MARION, INC.
Entity Type:Organization
Organization Name:FAMILY VISION CARE OF MARION, INC.
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:STRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-389-2306
Mailing Address - Street 1:228 BARKS RD E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6426
Mailing Address - Country:US
Mailing Address - Phone:740-389-2306
Mailing Address - Fax:
Practice Address - Street 1:228 BARKS RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6426
Practice Address - Country:US
Practice Address - Phone:740-389-2306
Practice Address - Fax:740-386-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4659T1434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4904000001Medicare NSC
OH0807741Medicare PIN
OHDN8929Medicare PIN