Provider Demographics
NPI:1902075815
Name:FAMILY VISION CARE, PA
Entity Type:Organization
Organization Name:FAMILY VISION CARE, PA
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-519-3350
Mailing Address - Street 1:900 W SAM HOUSTON BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5217
Mailing Address - Country:US
Mailing Address - Phone:956-781-3300
Mailing Address - Fax:956-781-8808
Practice Address - Street 1:900 W SAM HOUSTON BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5217
Practice Address - Country:US
Practice Address - Phone:956-781-3300
Practice Address - Fax:956-781-8808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY VISION CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5532T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019124901Medicaid
TX00501NMedicare PIN