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General NPI Number Information
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NPI Number | 1235130923
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CARE PC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 6525 A W HOUGHTON LAKE DR
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629
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Country | US
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Telephone | 989-422-5731
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Fax | 989-422-2534
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Provider Business Mailing Address
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Address Line | 6525 A W HOUGHTON LAKE DR
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9789
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Country | US
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Telephone | 989-422-5731
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Fax | 989-422-2534
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY CARL JENKINS
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Credential | OD
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Telephone | 989-422-5731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003630
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License Number State | MI
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