Provider Demographics
NPI:1699979211
Name:FAMILY VISION
Entity type:Organization
Organization Name:FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SUSCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-368-4660
Mailing Address - Street 1:1601 S VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5450
Mailing Address - Country:US
Mailing Address - Phone:215-368-4660
Mailing Address - Fax:215-368-7176
Practice Address - Street 1:1601 S VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5450
Practice Address - Country:US
Practice Address - Phone:215-368-4660
Practice Address - Fax:215-368-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024554Medicare PIN
PAU01335Medicare UPIN