Provider Demographics
NPI:1477582278
Name:FAMILY VISION CARE PA
Entity Type:Organization
Organization Name:FAMILY VISION CARE PA
Other - Org Name:VISION TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAVANCE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:904-625-2607
Mailing Address - Street 1:9365 ATLANTIC BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8218
Mailing Address - Country:US
Mailing Address - Phone:904-721-0704
Mailing Address - Fax:904-721-0706
Practice Address - Street 1:9365 ATLANTIC BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8218
Practice Address - Country:US
Practice Address - Phone:904-721-0704
Practice Address - Fax:904-721-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty