Provider Demographics
NPI:1134199722
Name:FAMILY EYE CARE PC
Entity type:Organization
Organization Name:FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-263-5654
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-0482
Mailing Address - Country:US
Mailing Address - Phone:712-263-5654
Mailing Address - Fax:712-263-8811
Practice Address - Street 1:1504 5TH AVE S
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2004
Practice Address - Country:US
Practice Address - Phone:712-263-5654
Practice Address - Fax:712-263-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2792283Medicaid
IA=========OtherUNICARE
IA=========OtherVSP
IA2792283Medicaid
IA=========OtherMIDLANDS CHOICE
IA=========OtherHUMANA
IA=========OtherHUMANA
IAI0901Medicare PIN
IA2792283Medicaid