Provider Demographics
NPI:1568585180
Name:FAMILY EYECARE ASSOCIATES PSC
Entity Type:Organization
Organization Name:FAMILY EYECARE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAEBE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-879-3665
Mailing Address - Street 1:105 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 CROSSFIELD DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1444
Practice Address - Country:US
Practice Address - Phone:859-879-3665
Practice Address - Fax:859-879-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1044-DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010445Medicaid
KY1295970001Medicare NSC
KY0932901Medicare PIN
KY77010445Medicaid