Provider Demographics
NPI:1194898015
Name:FAMILY OPTICAL CENTRE INC
Entity type:Organization
Organization Name:FAMILY OPTICAL CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRARA-FURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-544-3431
Mailing Address - Street 1:304 NO STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:815-544-3431
Mailing Address - Fax:815-544-6932
Practice Address - Street 1:304 NO STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008
Practice Address - Country:US
Practice Address - Phone:815-544-3431
Practice Address - Fax:815-544-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0792460001Medicare PIN
IL390920Medicare PIN