Basic Information
| Provider Information | |||||||||
| NPI: | 1366161226 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY FIRST VISION CARE KENTUCKY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 S HAMILTON RD | ||||||||
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| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432303350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146760550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2051 N BECHTLE AVE STE 130 | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455041583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373998000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6147611255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.