Provider Demographics
NPI:1467879916
Name:FAMILY VISION ASSOCIATES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:FAMILY VISION ASSOCIATES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPILOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-386-0111
Mailing Address - Street 1:415 PARSIPPANY RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5192
Mailing Address - Country:US
Mailing Address - Phone:973-386-0111
Mailing Address - Fax:973-386-1984
Practice Address - Street 1:415 PARSIPPANY RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5192
Practice Address - Country:US
Practice Address - Phone:973-386-0111
Practice Address - Fax:973-386-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-22
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00523000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0412520Medicaid
NJ0412520Medicaid
NJ7185150001Medicare NSC