1932144870 NPI number — FAMILY EYE CARE CENTER, P.C.

Table of content: (NPI 1932144870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932144870 NPI number — FAMILY EYE CARE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYE CARE CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROUCH VISION CLINIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932144870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5118 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57106-3520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-339-1939
Provider Business Mailing Address Fax Number:
605-330-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5118 W 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57106-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-339-1939
Provider Business Practice Location Address Fax Number:
605-330-0252
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FEJFAR
Authorized Official First Name:
VIRJEAN
Authorized Official Middle Name:
LORRAINE
Authorized Official Title or Position:
INSURANCE / BILLING
Authorized Official Telephone Number:
605-339-1939

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  526 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 527 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1250550001 . This is a "CIGNA DMERC REGION D" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9201512 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9201502 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30391 . This is a "SVHP KEVIN L CROUCH, OD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9231588 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 22508 . This is a "SVHP ASHLEY R CROUCH, OD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5214 . This is a "DAVIS VISION" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0004140 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: CV12701 . This is a "SPECTERA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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