Healthcare Provider Details

I. General information

NPI: 1154850139
Provider Name (Legal Business Name): FAMILY FIRST VISION CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WELLS RD STE 6
ORANGE PARK FL
32073-2372
US

IV. Provider business mailing address

1911 WELLS RD STE 6
ORANGE PARK FL
32073-2372
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-9700
  • Fax:
Mailing address:
  • Phone:
  • 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 WILLIAMS
Title or Position: COO
Credential:
Phone: 904-545-4465