Provider Demographics
NPI:1821196338
Name:COMPLETE FAMILY VISION CARE, INC.
Entity Type:Organization
Organization Name:COMPLETE FAMILY VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVRANEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-843-1870
Mailing Address - Street 1:1315 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4213
Mailing Address - Country:US
Mailing Address - Phone:724-843-1870
Mailing Address - Fax:724-843-7275
Practice Address - Street 1:1315 6TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4213
Practice Address - Country:US
Practice Address - Phone:724-843-1870
Practice Address - Fax:724-843-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00119257700001Medicaid
PACA5140OtherMEDICARE RAILROAD
PA0400040001Medicare NSC
PA00119257700001Medicaid