Provider Demographics
NPI:1417190778
Name:FAMILY EYE & VISION CARE
Entity Type:Organization
Organization Name:FAMILY EYE & VISION CARE
Other - Org Name:ANDREW P KRAFT O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-242-2020
Mailing Address - Street 1:126 S INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5624
Mailing Address - Country:US
Mailing Address - Phone:580-242-2020
Mailing Address - Fax:580-234-1699
Practice Address - Street 1:126 S INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5624
Practice Address - Country:US
Practice Address - Phone:580-242-2020
Practice Address - Fax:580-234-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2321152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522057Medicare PIN