Provider Demographics
NPI:1801099247
Name:FAMILY OPTOMETRIC CENTERS PLC
Entity type:Organization
Organization Name:FAMILY OPTOMETRIC CENTERS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-832-3218
Mailing Address - Street 1:142 W UPTON AVE
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-1130
Mailing Address - Country:US
Mailing Address - Phone:231-832-3218
Mailing Address - Fax:231-832-3628
Practice Address - Street 1:142 W UPTON AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-1130
Practice Address - Country:US
Practice Address - Phone:231-832-3218
Practice Address - Fax:231-832-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0786750001Medicare NSC
MI0P11250Medicare ID - Type Unspecified