MEDICARE: CENTER FOR FAMILY VISION, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28598	OTHER	MA	BMC HEALTHNET
2	W20176	OTHER	MA	BLUE CROSS BLUE SHEILD
3	28640	OTHER	RI	NEIGHBORHOOD HEALTH PLAN
4	97422514	OTHER	MA	MASSHEALTH

General Provider Information

NPI Number	:	1861571754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FAMILY VISION, PC

Provider Business Mailing Address
First Line	:	920 PLYMOUTH AVE
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02721-1944
Country	:	US
Telephone Number	:	508-673-5831
Fax Number	:	508-676-2128

Provider Business Practice Location Address
First Line	:	920 PLYMOUTH AVE
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02721-1944
Country	:	US
Telephone Number	:	508-673-5831
Fax Number	:	508-676-2128

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUDOXIA E TSONGALIS-ARRUDA
Credential	:	OD
Telephone Number	:	508-673-5831

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	01/22/2010

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