NPI Record of FAMILY VISION OF CRESTVIEW LLC NPI 1003413444

Eyewear Supplier in Crestview, FL

Complete NPI Record

Field Name Value Definition
NPI1003413444The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameFAMILY VISION OF CRESTVIEW LLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address535 S FERDON BLVD STE BThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameCRESTVIEWThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameFLThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code325364446The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8503313918The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8506346127The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address535 S FERDON BLVD STE BThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCRESTVIEWThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameFLThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code325364446The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S US
Provider Business Practice Location Address Telephone Number8503313918
Provider Business Practice Location Address Fax Number8506346127Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Enumeration Date10/8/2020The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date10/8/2020The date that a record was last updated or changed.
Authorized Official Last NameCOXThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameDAVIDThe first name of the authorized official.
Authorized Official Middle NameWThe middle name of the authorized official.
Authorized Official Title or PositionPRESIDENTThe title or position of the authorized official.
Authorized Official Telephone Number8033313918The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1332H00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Name Prefix TextMR.
Authorized Official Credential TextLICENSED OPTICIAN
NPI Certification Date10/8/2020