Provider Demographics
NPI:1235130923
Name:FAMILY EYE CARE PC
Entity type:Organization
Organization Name:FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-422-5731
Mailing Address - Street 1:6525 A W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9789
Mailing Address - Country:US
Mailing Address - Phone:989-422-5731
Mailing Address - Fax:989-422-2534
Practice Address - Street 1:6525 A W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629
Practice Address - Country:US
Practice Address - Phone:989-422-5731
Practice Address - Fax:989-422-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13147OtherSPECTERA
MI943380772Medicaid
MI1178430001OtherDMERC
MI900G210280OtherBLUE CROSS BLUE SHIELD
MI943380807Medicaid
MI900022079OtherPRIORITY HEALTH
MIDE5176OtherDMERC
MIP35872FOtherBLUE CARE NETWORK
MI13146OtherSPECTERA
MI230603OtherNVA
MI3630OtherEYEMED
MI410036674OtherRAILROAD MEDICARE
MI900G210200OtherBLUE CARE NETWORK
MI00050136929OtherAETNA
MI900G210200OtherBLUE CROSS BLUE SHIELD
MI943380807Medicaid
MI410036674OtherRAILROAD MEDICARE