Healthcare Provider Details

I. General information

NPI: 1255400933
Provider Name (Legal Business Name): FAMILYLIFE VISION CARE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 BLUEGRASS DR STE A
HIGHLAND HEIGHTS KY
41076-1589
US

IV. Provider business mailing address

2816 BLUEGRASS DR STE A
HIGHLAND HEIGHTS KY
41076-1589
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-3400
  • Fax: 859-572-4822
Mailing address:
  • Phone: 859-441-3400
  • Fax: 859-572-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1196DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1108DT
License Number StateKY

VIII. Authorized Official

Name: DR. DOUGLAS J. GARBIG
Title or Position: DOCTOR
Credential: O.D.
Phone: 859-441-3400