Provider Demographics
NPI:1154569234
Name:FAMILY OPTOMETRIC VISION CARE
Entity type:Organization
Organization Name:FAMILY OPTOMETRIC VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-757-5560
Mailing Address - Street 1:5163 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8689
Mailing Address - Country:US
Mailing Address - Phone:925-757-5560
Mailing Address - Fax:925-757-5577
Practice Address - Street 1:5163 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:925-757-5560
Practice Address - Fax:925-757-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5780 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057802Medicaid
CASD0057802Medicaid