Provider Demographics
NPI:1639875826
Name:FAMILY FIRST VISION CARE ARIZONA PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST VISION CARE ARIZONA PLLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-236-7067
Mailing Address - Street 1:PO BOX 631665
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1665
Mailing Address - Country:US
Mailing Address - Phone:614-831-0268
Mailing Address - Fax:
Practice Address - Street 1:2730 W DOVE VALLEY RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5253
Practice Address - Country:US
Practice Address - Phone:614-831-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST POINT OPTICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-31
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty