Provider Demographics
NPI:1477627131
Name:FAMILY EYE CARE, P.C.
Entity Type:Organization
Organization Name:FAMILY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-359-2020
Mailing Address - Street 1:5590 MAIN ST., SUITE 1
Mailing Address - Street 2:PO BOX 51
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450
Mailing Address - Country:US
Mailing Address - Phone:810-359-2020
Mailing Address - Fax:810-359-8720
Practice Address - Street 1:5590 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450
Practice Address - Country:US
Practice Address - Phone:810-359-2020
Practice Address - Fax:810-359-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P22430Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
MIV06719Medicare UPIN
MI5525970001Medicare NSC