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General NPI Number Information
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NPI Number | 1235697061
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Entity Type | Organization
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Legal Business Name | FAMILY VISION ENTERPRISES
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 6201 N FRONT ST STE 119
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City | PHILADELPHIA
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State | PA
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Zip | 19120-1541
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Country | US
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Telephone | 215-927-2250
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Fax | 215-927-2293
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Provider Business Mailing Address
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Address Line | 6201 N FRONT ST STE 119
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City | PHILADELPHIA
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State | PA
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Zip | 19120-1541
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Country | US
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Telephone | 215-927-2250
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Fax | 215-927-2293
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JUAN E. RODRIGUEZ
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Credential | O.D.
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Telephone | 215-927-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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