Provider Demographics
NPI:1407929300
Name:FAMILY EYECARE CENTER PC
Entity Type:Organization
Organization Name:FAMILY EYECARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MEGGINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-793-2020
Mailing Address - Street 1:401 PINEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4001
Mailing Address - Country:US
Mailing Address - Phone:434-793-2020
Mailing Address - Fax:434-792-0102
Practice Address - Street 1:401 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4001
Practice Address - Country:US
Practice Address - Phone:434-793-2020
Practice Address - Fax:434-792-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009236431Medicaid
VA410001283Medicare PIN
VA4504190001Medicare NSC
VAU22909Medicare UPIN