Provider Demographics
NPI:1255400933
Name:FAMILYLIFE VISION CARE, PSC
Entity type:Organization
Organization Name:FAMILYLIFE VISION CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARBIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-441-3400
Mailing Address - Street 1:2816 BLUEGRASS DR STE A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1589
Mailing Address - Country:US
Mailing Address - Phone:859-441-3400
Mailing Address - Fax:859-572-4822
Practice Address - Street 1:2816 BLUEGRASS DR STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1589
Practice Address - Country:US
Practice Address - Phone:859-441-3400
Practice Address - Fax:859-572-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1196DT152WV0400X
KY1108DT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCG7465OtherRR MEDICARE GROUP
KY2324352OtherAETNA
KY10654348379OtherHUMANA
KY0470570001Medicare NSC
KY2324352OtherAETNA