Provider Demographics
NPI:1134342793
Name:FAMILY VISION CARE PA
Entity type:Organization
Organization Name:FAMILY VISION CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-519-3350
Mailing Address - Street 1:207 W PALMA VISTA DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2126
Mailing Address - Country:US
Mailing Address - Phone:956-519-3350
Mailing Address - Fax:956-519-3866
Practice Address - Street 1:207 W PALMA VISTA DR
Practice Address - Street 2:SUITE I
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-2126
Practice Address - Country:US
Practice Address - Phone:956-519-3350
Practice Address - Fax:956-519-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019124901Medicaid
TX019124901Medicaid