Provider Demographics
NPI:1528256971
Name:FAMILY EYECARE CENTER, INC.
Entity type:Organization
Organization Name:FAMILY EYECARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEMPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-323-5213
Mailing Address - Street 1:1601 AVE D
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-2559
Mailing Address - Country:US
Mailing Address - Phone:712-323-5213
Mailing Address - Fax:
Practice Address - Street 1:1601 AVE D
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2559
Practice Address - Country:US
Practice Address - Phone:712-323-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT00854Medicare UPIN
V05992Medicare UPIN
IA0196690001Medicare NSC