Provider Demographics
NPI:1780913343
Name:FAMILY EYECARE CENTER, LLC
Entity type:Organization
Organization Name:FAMILY EYECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAMPIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:O D
Authorized Official - Phone:601-957-8444
Mailing Address - Street 1:8 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4113
Mailing Address - Country:US
Mailing Address - Phone:601-957-8444
Mailing Address - Fax:888-310-6369
Practice Address - Street 1:815 S WHEATLEY ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5002
Practice Address - Country:US
Practice Address - Phone:601-983-2633
Practice Address - Fax:601-956-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01459034Medicaid