Provider Demographics
NPI:1578854451
Name:FAMILY EYECARE CENTER LANSING LLC
Entity Type:Organization
Organization Name:FAMILY EYECARE CENTER LANSING LLC
Other - Org Name:LANSING FAMILY EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-682-2929
Mailing Address - Street 1:301 CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6352
Mailing Address - Country:US
Mailing Address - Phone:913-682-2020
Mailing Address - Fax:913-682-2999
Practice Address - Street 1:301 CENTRE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6352
Practice Address - Country:US
Practice Address - Phone:913-682-2020
Practice Address - Fax:913-682-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
KS1849152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty