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General NPI Number Information
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NPI Number | 1255507075
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Entity Type | Organization
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Legal Business Name | FAMILY EYECARE CENTER, LLC.
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 21178 OLEAN BLVD UNIT A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6728
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Country | US
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Telephone | 941-629-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 21178 OLEAN BLVD UNIT A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6728
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Country | US
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Telephone | 941-629-1090
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | CRAIG CZYZ
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Credential | D.O.
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Telephone | 941-629-1090
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS10225
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License Number State | FL
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