Provider Demographics
NPI:1427552447
Name:FAMILY VISION PC
Entity Type:Organization
Organization Name:FAMILY VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-226-6041
Mailing Address - Street 1:2808 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2300
Mailing Address - Country:US
Mailing Address - Phone:864-226-6041
Mailing Address - Fax:864-226-1232
Practice Address - Street 1:2808 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2300
Practice Address - Country:US
Practice Address - Phone:864-226-6041
Practice Address - Fax:864-226-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty