Provider Demographics
NPI:1043382609
Name:FAMILY VISION AND EYE CARE PA
Entity type:Organization
Organization Name:FAMILY VISION AND EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-436-3455
Mailing Address - Street 1:714 G ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1612
Mailing Address - Country:US
Mailing Address - Phone:208-436-3455
Mailing Address - Fax:208-436-3195
Practice Address - Street 1:714 G ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1612
Practice Address - Country:US
Practice Address - Phone:208-436-3455
Practice Address - Fax:208-436-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4991580001OtherDMERC NUMBER
ID1376024Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER