Provider Demographics
NPI:1477731131
Name:FAMILY EYE CARE
Entity Type:Organization
Organization Name:FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNSWICK
Authorized Official - Middle Name:ROYALTON
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-332-7229
Mailing Address - Street 1:411 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4816
Mailing Address - Country:US
Mailing Address - Phone:662-332-7229
Mailing Address - Fax:662-378-3949
Practice Address - Street 1:411 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4816
Practice Address - Country:US
Practice Address - Phone:662-332-7229
Practice Address - Fax:662-378-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0627780001Medicare NSC