Provider Demographics
NPI:1063441129
Name:FAMILY VISION ASSOCIATES,PA
Entity type:Organization
Organization Name:FAMILY VISION ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-854-1833
Mailing Address - Street 1:5431 EVERHART RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4805
Mailing Address - Country:US
Mailing Address - Phone:361-854-1833
Mailing Address - Fax:361-852-1210
Practice Address - Street 1:5431 EVERHART RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4805
Practice Address - Country:US
Practice Address - Phone:361-854-1833
Practice Address - Fax:361-852-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6733TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E51GMedicare ID - Type UnspecifiedFVA ID