Provider Demographics
NPI:1780805804
Name:FAMILY EYE CARE CENTER PA
Entity type:Organization
Organization Name:FAMILY EYE CARE CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-265-2020
Mailing Address - Street 1:717 GREENWAY ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4991
Mailing Address - Country:US
Mailing Address - Phone:828-265-2020
Mailing Address - Fax:828-264-2257
Practice Address - Street 1:717 GREENWAY ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4991
Practice Address - Country:US
Practice Address - Phone:828-265-2020
Practice Address - Fax:828-264-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC152W00000XOtherTAXONOMY
NC8909826Medicaid
NC8909826Medicaid
NC5366440001Medicare NSC
2341873Medicare PIN