Provider Demographics
NPI:1831270115
Name:FAMILY VISION CARE ASSOCIATES, PC
Entity type:Organization
Organization Name:FAMILY VISION CARE ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-266-1300
Mailing Address - Street 1:74 WELWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-1577
Mailing Address - Country:US
Mailing Address - Phone:570-266-1300
Mailing Address - Fax:570-266-3800
Practice Address - Street 1:74 WELWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1577
Practice Address - Country:US
Practice Address - Phone:570-266-1300
Practice Address - Fax:570-266-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5271950001Medicare NSC
PA062564Medicare PIN
U86478Medicare UPIN