Provider Demographics
NPI:1518146513
Name:FAMILY EYECARE CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY EYECARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-543-7376
Mailing Address - Street 1:629 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2221
Mailing Address - Country:US
Mailing Address - Phone:423-543-7376
Mailing Address - Fax:423-543-6604
Practice Address - Street 1:629 BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2221
Practice Address - Country:US
Practice Address - Phone:423-543-7376
Practice Address - Fax:423-543-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6146570001Medicare NSC