Provider Demographics
NPI:1831378991
Name:FAMILY EYE CARE, PA
Entity type:Organization
Organization Name:FAMILY EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPERTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-751-4483
Mailing Address - Street 1:1840 DUNN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4785
Mailing Address - Country:US
Mailing Address - Phone:904-751-4483
Mailing Address - Fax:904-751-0890
Practice Address - Street 1:1840 DUNN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4785
Practice Address - Country:US
Practice Address - Phone:904-751-4483
Practice Address - Fax:904-751-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078748500Medicaid
FL19543Medicare PIN
FL078748500Medicaid