Provider Demographics
NPI:1013071588
Name:FAMILY VISION TRENDS LLC
Entity type:Organization
Organization Name:FAMILY VISION TRENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-329-3937
Mailing Address - Street 1:1021 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6365
Mailing Address - Country:US
Mailing Address - Phone:405-329-3937
Mailing Address - Fax:405-329-3556
Practice Address - Street 1:1021 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6365
Practice Address - Country:US
Practice Address - Phone:405-329-3937
Practice Address - Fax:405-329-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200195950AMedicaid
OK200016870AMedicaid
241332202OtherPTAN GROUP
OK200195950AMedicaid
OKU97187Medicare UPIN
OK200016870AMedicaid