Provider Demographics
NPI:1508230889
Name:OAK CREEK FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:OAK CREEK FAMILY EYE CARE LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:FACCHIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-764-2651
Mailing Address - Street 1:8907 S HOWELL AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4461
Mailing Address - Country:US
Mailing Address - Phone:414-764-2651
Mailing Address - Fax:
Practice Address - Street 1:8907 S HOWELL AVE STE 600
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4461
Practice Address - Country:US
Practice Address - Phone:414-764-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty