Provider Demographics
NPI:1891826566
Name:OREGON FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:OREGON FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-835-6658
Mailing Address - Street 1:600 PLEASANT OAK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3648
Mailing Address - Country:US
Mailing Address - Phone:608-835-6658
Mailing Address - Fax:
Practice Address - Street 1:600 PLEASANT OAK DR
Practice Address - Street 2:SUITE D
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-3648
Practice Address - Country:US
Practice Address - Phone:608-835-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty