Provider Demographics
NPI:1932144870
Name:FAMILY EYE CARE CENTER, P.C.
Entity Type:Organization
Organization Name:FAMILY EYE CARE CENTER, P.C.
Other - Org Name:CROUCH VISION CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE / BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRJEAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:FEJFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-339-1939
Mailing Address - Street 1:5118 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3520
Mailing Address - Country:US
Mailing Address - Phone:605-339-1939
Mailing Address - Fax:605-330-0252
Practice Address - Street 1:5118 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3520
Practice Address - Country:US
Practice Address - Phone:605-339-1939
Practice Address - Fax:605-330-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD526152W00000X
SD527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1250550001OtherCIGNA DMERC REGION D
SD9201512Medicaid
SD9201502Medicaid
SD30391OtherSVHP KEVIN L CROUCH, OD
SD9231588OtherDAKOTACARE
SD22508OtherSVHP ASHLEY R CROUCH, OD
SD5214OtherDAVIS VISION
SD0004140OtherBLUECROSS BLUESHIELD
SDCV12701OtherSPECTERA
SD0004140OtherBLUECROSS BLUESHIELD
SD9201502Medicaid
SD9201512Medicaid
SD6353000001Medicare NSC