Provider Demographics
NPI:1043478704
Name:FAMILY VISION ASSOCIATES, P.A.
Entity type:Organization
Organization Name:FAMILY VISION ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAUGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-627-1114
Mailing Address - Street 1:11380 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3464
Mailing Address - Country:US
Mailing Address - Phone:561-627-1114
Mailing Address - Fax:561-627-2304
Practice Address - Street 1:11380 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE 119
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3464
Practice Address - Country:US
Practice Address - Phone:561-627-1114
Practice Address - Fax:561-627-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078980100Medicaid
FL19389OtherBLUE CROSS & BLUE SHIELD OF FLORIDA
FL19389OtherBLUE CROSS & BLUE SHIELD OF FLORIDA
FLT85265Medicare UPIN
FL0466910001Medicare NSC