Healthcare Provider Details

I. General information

NPI: 1902417595
Provider Name (Legal Business Name): FAMILY FIRST VISION CARE KENTUCKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 11/20/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 PALOMAR CENTRE DR STE 170
LEXINGTON KY
40513-1121
US

IV. Provider business mailing address

3735 PALOMAR CENTRE DR STE 170
LEXINGTON KY
40513-1121
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-8080
  • Fax:
Mailing address:
  • Phone: 859-781-8080
  • 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