Provider Demographics
NPI:1144490384
Name:FAMILY VISION CARE P.A.
Entity type:Organization
Organization Name:FAMILY VISION CARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUELLERLEILE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-451-5800
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0412
Mailing Address - Country:US
Mailing Address - Phone:507-451-5800
Mailing Address - Fax:507-451-4884
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2970
Practice Address - Country:US
Practice Address - Phone:507-451-5800
Practice Address - Fax:507-451-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD1524000332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0178930001Medicare NSC
MNT65896Medicare UPIN