Provider Demographics
NPI:1902112667
Name:FAMILY VISION CLINIC
Entity Type:Organization
Organization Name:FAMILY VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-565-2848
Mailing Address - Street 1:8801 BASELINE ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209
Mailing Address - Country:US
Mailing Address - Phone:501-565-2848
Mailing Address - Fax:501-565-2724
Practice Address - Street 1:8801 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5901
Practice Address - Country:US
Practice Address - Phone:501-565-2848
Practice Address - Fax:501-565-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART97974Medicare UPIN