Provider Demographics
NPI:1295922094
Name:PRANGE FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:PRANGE FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:THEA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-372-0075
Mailing Address - Street 1:2121 HUDSON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2379
Mailing Address - Country:US
Mailing Address - Phone:269-345-2916
Mailing Address - Fax:269-345-5335
Practice Address - Street 1:2121 HUDSON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2379
Practice Address - Country:US
Practice Address - Phone:269-345-2916
Practice Address - Fax:269-345-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies