Healthcare Provider Details

I. General information

NPI: 1902486913
Provider Name (Legal Business Name): FAMILY FIRST VISION CARE KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 HUNTLEY PKWY
PELHAM AL
35124
US

IV. Provider business mailing address

316 S HAMILTON RD
GAHANNA OH
43230-3350
US

V. Phone/Fax

Practice location:
  • Phone: 205-624-2015
  • Fax:
Mailing address:
  • Phone: 904-545-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM R WILLIAMS
Title or Position: COO
Credential:
Phone: 904-545-4465