Healthcare Provider Details

I. General information

NPI: 1326002957
Provider Name (Legal Business Name): FAMILY VISION CARE OF KINGSTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PIERCE ST
KINGSTON PA
18704-5532
US

IV. Provider business mailing address

390 PIERCE ST
KINGSTON PA
18704-5532
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-2600
  • Fax:
Mailing address:
  • Phone: 570-714-2600
  • Fax: 570-714-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CARL URBANSKI
Title or Position: OWNER
Credential: OD
Phone: 570-714-2600