Provider Demographics
NPI:1548703531
Name:FAMILY VISION CENTER SOUTH
Entity type:Organization
Organization Name:FAMILY VISION CENTER SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKITES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-229-8103
Mailing Address - Street 1:PO BOX 240161
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-0161
Mailing Address - Country:US
Mailing Address - Phone:907-569-2030
Mailing Address - Fax:
Practice Address - Street 1:8900 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2022
Practice Address - Country:US
Practice Address - Phone:907-569-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty