Provider Demographics
NPI:1720283880
Name:FAMILY VISION CLINIC, INC.
Entity Type:Organization
Organization Name:FAMILY VISION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-849-5004
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-0962
Mailing Address - Country:US
Mailing Address - Phone:601-849-5004
Mailing Address - Fax:601-849-2801
Practice Address - Street 1:450 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3960
Practice Address - Country:US
Practice Address - Phone:601-849-5004
Practice Address - Fax:601-849-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880069Medicaid
MS00880069Medicaid