MEDICARE: FAMILY FIRST VISION CARE KENTUCKY, LLC

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

General Provider Information

NPI Number	:	1912626888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST VISION CARE KENTUCKY, LLC

Provider Business Mailing Address
First Line	:	316 S HAMILTON RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3350
Country	:	US
Telephone Number	:	614-676-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5274 SALEM AVE
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1702
Country	:	US
Telephone Number	:	937-837-3937
Fax Number	:

Authorized Official
Title or Position	:	CREDENTAILING SPECIALIST
Name	:	SARAH DOWLING
Credential	:
Telephone Number	:	614-761-1255

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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