Provider Demographics
NPI:1942481726
Name:FAMILY EYECARE AND CONTACT LENS
Entity Type:Organization
Organization Name:FAMILY EYECARE AND CONTACT LENS
Other - Org Name:KIRK D KVITLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-231-3937
Mailing Address - Street 1:3325 MAINE STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4438
Mailing Address - Country:US
Mailing Address - Phone:217-231-3937
Mailing Address - Fax:217-231-3940
Practice Address - Street 1:3325 MAINE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4438
Practice Address - Country:US
Practice Address - Phone:217-231-3937
Practice Address - Fax:217-231-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4092290001Medicare NSC
IL623150Medicare PIN