Provider Demographics
NPI:1376731935
Name:FAMILY EYE & CONTACT LENS CTR
Entity Type:Organization
Organization Name:FAMILY EYE & CONTACT LENS CTR
Other - Org Name:NEWVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSCOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-232-1633
Mailing Address - Street 1:2448 76TH AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2781
Mailing Address - Country:US
Mailing Address - Phone:206-232-1633
Mailing Address - Fax:206-232-2055
Practice Address - Street 1:2448 76TH AVE SE
Practice Address - Street 2:SUITE 106
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2781
Practice Address - Country:US
Practice Address - Phone:206-232-1633
Practice Address - Fax:206-232-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU64676Medicare UPIN