Provider Demographics
NPI:1134354145
Name:FAMILY OPTOMETRY, P.C.
Entity type:Organization
Organization Name:FAMILY OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-963-8833
Mailing Address - Street 1:2950 N DOBSON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1800
Mailing Address - Country:US
Mailing Address - Phone:480-963-8833
Mailing Address - Fax:480-963-3766
Practice Address - Street 1:2950 N DOBSON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1800
Practice Address - Country:US
Practice Address - Phone:480-963-8833
Practice Address - Fax:480-963-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ553152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68299Medicare PIN