Provider Demographics
NPI:1972048460
Name:FANG VISION CARE LLC
Entity Type:Organization
Organization Name:FANG VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-920-9390
Mailing Address - Street 1:420 BUCKLAND HILLS DR
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8755
Mailing Address - Country:US
Mailing Address - Phone:860-644-1203
Mailing Address - Fax:
Practice Address - Street 1:420 BUCKLAND HILLS DR
Practice Address - Street 2:VISION CENTER
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8755
Practice Address - Country:US
Practice Address - Phone:860-644-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty