Healthcare Provider Details

I. General information

NPI: 1275678286
Provider Name (Legal Business Name): FAMILY VISION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 PEARL ST
EUGENE OR
97401-4009
US

IV. Provider business mailing address

1471 PEARL ST
EUGENE OR
97401-4009
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1237
  • Fax: 541-484-2026
Mailing address:
  • Phone: 541-686-1237
  • Fax: 541-484-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1192ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MISS JENNIFER PIELAET
Title or Position: BILLING SPECIALIST
Credential:
Phone: 541-686-1237