Provider Demographics
NPI:1487625067
Name:FAMILY VISION CENTER INC
Entity type:Organization
Organization Name:FAMILY VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-377-3937
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-0826
Mailing Address - Country:US
Mailing Address - Phone:262-377-3937
Mailing Address - Fax:262-377-3948
Practice Address - Street 1:W63 N543B HANOVER AVENUE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-0826
Practice Address - Country:US
Practice Address - Phone:262-377-3937
Practice Address - Fax:262-377-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87988Medicare ID - Type Unspecified
WI0771770001Medicare NSC
U41198Medicare UPIN