Provider Demographics
NPI:1417119744
Name:FAMILY EYE CARE CENTER OF AUSTIN INC.
Entity Type:Organization
Organization Name:FAMILY EYE CARE CENTER OF AUSTIN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-437-3227
Mailing Address - Street 1:200 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4645
Mailing Address - Country:US
Mailing Address - Phone:507-437-3227
Mailing Address - Fax:507-437-8070
Practice Address - Street 1:200 14TH ST NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4645
Practice Address - Country:US
Practice Address - Phone:507-437-3227
Practice Address - Fax:507-437-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6210400001Medicare NSC