Provider Demographics
NPI:1023249349
Name:FAMILY EYECARE OPTOMETRY CENTER PC
Entity type:Organization
Organization Name:FAMILY EYECARE OPTOMETRY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-688-6612
Mailing Address - Street 1:2030 VIBORG RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3219
Mailing Address - Country:US
Mailing Address - Phone:805-688-6612
Mailing Address - Fax:805-686-5822
Practice Address - Street 1:2030 VIBORG RD
Practice Address - Street 2:STE 105
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3219
Practice Address - Country:US
Practice Address - Phone:805-688-6612
Practice Address - Fax:805-686-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12937 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023249349OtherCIGNA
CACS006AMedicare PIN