Provider Demographics
NPI:1821150970
Name:FAMILY EYECARE CENTER
Entity Type:Organization
Organization Name:FAMILY EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TINGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-9111
Mailing Address - Street 1:1500 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3327
Mailing Address - Country:US
Mailing Address - Phone:304-636-9111
Mailing Address - Fax:614-923-9575
Practice Address - Street 1:1500 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3327
Practice Address - Country:US
Practice Address - Phone:304-636-9111
Practice Address - Fax:614-923-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV867-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821150970OtherGROUP NPI
WV0149464000Medicaid
WV3810006295Medicaid
WV0150280000Medicaid
WV1992795835OtherNPI CRAIG C. HYRE
WV1447240205OtherNPI EDWARD CLIFTON HYRE
WV0470900001Medicare NSC
WV1992795835OtherNPI CRAIG C. HYRE
WVT32458Medicare UPIN
WV0149464000Medicaid