Healthcare Provider Details

I. General information

NPI: 1053059287
Provider Name (Legal Business Name): FAMILY FIRST VISION CARE KENTUCKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 FREDERICA ST
OWENSBORO KY
42301-7515
US

IV. Provider business mailing address

316 S HAMILTON RD
GAHANNA OH
43230-3350
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-8811
  • Fax:
Mailing address:
  • Phone: 614-676-0550
  • Fax: 317-534-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH DOWLING
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 614-761-1255