Provider Demographics
NPI:1659644433
Name:FAMILY VISION CARE, INC.
Entity Type:Organization
Organization Name:FAMILY VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:V
Authorized Official - Last Name:LOCASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-874-8125
Mailing Address - Street 1:2314 SW 336TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2848
Mailing Address - Country:US
Mailing Address - Phone:253-874-8125
Mailing Address - Fax:253-874-8184
Practice Address - Street 1:2314 SW 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2848
Practice Address - Country:US
Practice Address - Phone:253-874-8125
Practice Address - Fax:253-874-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601862098332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021376Medicaid
WA2021376Medicaid
WAG8906636Medicare PIN
U20873Medicare UPIN