Healthcare Provider Details

I. General information

NPI: 1396913257
Provider Name (Legal Business Name): FAMILY VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S COMMERCE ST
GENEVA AL
36340-2410
US

IV. Provider business mailing address

607 S COMMERCE ST
GENEVA AL
36340-2410
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-6070
  • Fax: 334-684-2640
Mailing address:
  • Phone: 334-684-6070
  • Fax: 334-684-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS584TA252
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN E HORNSBY
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 334-684-6070