Provider Demographics
NPI:1790755197
Name:FAMILY EYE CARE CLINIC PC
Entity Type:Organization
Organization Name:FAMILY EYE CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-796-8288
Mailing Address - Street 1:719 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3425
Mailing Address - Country:US
Mailing Address - Phone:903-796-8288
Mailing Address - Fax:903-796-9071
Practice Address - Street 1:719 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3425
Practice Address - Country:US
Practice Address - Phone:903-796-8288
Practice Address - Fax:903-796-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2702TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00E75WMedicare ID - Type Unspecified
TX0761190001Medicare NSC