Provider Demographics
NPI:1609924398
Name:FAMILY VISION CARE OF ALLIANCE, INC.
Entity Type:Organization
Organization Name:FAMILY VISION CARE OF ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBENSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-821-5367
Mailing Address - Street 1:1370 S SAWBURG AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5761
Mailing Address - Country:US
Mailing Address - Phone:330-821-5367
Mailing Address - Fax:330-821-1981
Practice Address - Street 1:1370 S SAWBURG AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5761
Practice Address - Country:US
Practice Address - Phone:330-821-5367
Practice Address - Fax:330-821-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3508152W00000X
OH4975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215547Medicaid
OH0215547Medicaid
OH5076970001Medicare NSC