Healthcare Provider Details

I. General information

NPI: 1205081080
Provider Name (Legal Business Name): FAMILY VISION CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 CROSSING CIR
TRAVERSE CITY MI
49684-7930
US

IV. Provider business mailing address

2640 CROSSING CIR
TRAVERSE CITY MI
49684-7930
US

V. Phone/Fax

Practice location:
  • Phone: 231-933-7195
  • Fax: 231-933-7197
Mailing address:
  • Phone: 231-933-7195
  • Fax: 231-933-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004141
License Number StateMI

VIII. Authorized Official

Name: DR. ROSEANNA MARIE DAVID
Title or Position: PRESIDENT
Credential: O.D.
Phone: 231-933-7195