Provider Demographics
NPI:1740489442
Name:FAMILY EYECARE, INC.
Entity type:Organization
Organization Name:FAMILY EYECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-946-8809
Mailing Address - Street 1:77 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1615
Mailing Address - Country:US
Mailing Address - Phone:440-352-0616
Mailing Address - Fax:403-520-6184
Practice Address - Street 1:7200 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7522
Practice Address - Country:US
Practice Address - Phone:440-946-8809
Practice Address - Fax:440-269-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104896Medicaid
OH2104896Medicaid
OH1258080001Medicare NSC
OHDF1230Medicare PIN