Provider Demographics
NPI:1861715104
Name:FAMILY EYE CARE CENTER INC
Entity type:Organization
Organization Name:FAMILY EYE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASSIT.
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-364-1252
Mailing Address - Street 1:819 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3930
Mailing Address - Country:US
Mailing Address - Phone:702-878-1908
Mailing Address - Fax:702-878-0761
Practice Address - Street 1:819 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3930
Practice Address - Country:US
Practice Address - Phone:702-878-1908
Practice Address - Fax:702-878-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2502012Medicaid