Provider Demographics
NPI:1356386155
Name:FAMILY FOCUSED VISION CARE, LLC
Entity type:Organization
Organization Name:FAMILY FOCUSED VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LA COUNT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-989-2012
Mailing Address - Street 1:957 MELISSA ST
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-2013
Mailing Address - Country:US
Mailing Address - Phone:920-751-8824
Mailing Address - Fax:
Practice Address - Street 1:W575 CASTLE DR.
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:WI
Practice Address - Zip Code:54169
Practice Address - Country:US
Practice Address - Phone:920-989-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU53662Medicare UPIN