Provider Demographics
NPI:1053715433
Name:ADVANCED FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:ADVANCED FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-425-0758
Mailing Address - Street 1:3940 RENNES DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5690
Mailing Address - Country:US
Mailing Address - Phone:614-425-0758
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY VILLAGE DR
Practice Address - Street 2:STE 2
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7613
Practice Address - Country:US
Practice Address - Phone:614-425-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty