Healthcare Provider Details

I. General information

NPI: 1396396750
Provider Name (Legal Business Name): FAMILY FIRST VISION CARE KENTUCKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 11/20/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 BUTTERMILK PIKE
FORT MITCHELL KY
41017
US

IV. Provider business mailing address

4680 PARKWAY DR STE 455
MASON OH
45040-8199
US

V. Phone/Fax

Practice location:
  • Phone: 859-320-0221
  • Fax:
Mailing address:
  • Phone: 513-445-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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