Provider Demographics
NPI:1619759453
Name:BEND FAMILY VISION CARE LLC
Entity Type:Organization
Organization Name:BEND FAMILY VISION CARE LLC
Other - Org Name:BEND FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-740-8021
Mailing Address - Street 1:1470 SW KNOLL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3154
Mailing Address - Country:US
Mailing Address - Phone:541-797-0295
Mailing Address - Fax:541-797-7685
Practice Address - Street 1:1470 SW KNOLL AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3154
Practice Address - Country:US
Practice Address - Phone:541-797-0295
Practice Address - Fax:541-797-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear Supplier