Provider Demographics
NPI:1659800803
Name:FAYETTE FAMILY VISION CARE
Entity Type:Organization
Organization Name:FAYETTE FAMILY VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VRANICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-465-3130
Mailing Address - Street 1:3161 HIGHWAY 64 STE 500
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3370
Mailing Address - Country:US
Mailing Address - Phone:901-465-3130
Mailing Address - Fax:
Practice Address - Street 1:3161 HIGHWAY 64 STE 500
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3370
Practice Address - Country:US
Practice Address - Phone:901-465-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty