Provider Demographics
NPI:1861818890
Name:DIMOCK FAMILY EYECARE LLC
Entity type:Organization
Organization Name:DIMOCK FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAILLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-278-2882
Mailing Address - Street 1:7473 ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:DIMOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7473 ROUTE 29
Practice Address - Street 2:
Practice Address - City:DIMOCK
Practice Address - State:PA
Practice Address - Zip Code:18816
Practice Address - Country:US
Practice Address - Phone:570-278-2882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty