Provider Demographics
NPI:1053554147
Name:FAMILY EYE CENTER
Entity type:Organization
Organization Name:FAMILY EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-438-6132
Mailing Address - Street 1:134 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-8605
Mailing Address - Country:US
Mailing Address - Phone:252-257-3675
Mailing Address - Fax:
Practice Address - Street 1:134 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-8605
Practice Address - Country:US
Practice Address - Phone:252-257-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0212770003Medicare NSC