NPIMap

Organization Active NPI

Family First Vision Care Indiana LLC

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1497125017
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY FIRST VISION CARE INDIANA LLC
Practice address
4201 Coldwater Rd
Fort Wayne, IN 46805-1113
Phone
(260) 483-9568
NPI assigned
Sep 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Jandernal
Title
Credentialing Manager
Phone
(732) 236-7067

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4201 Coldwater Rd
Fort Wayne, IN 46805-1113

Mailing address

PO Box 631665
Cincinnati, OH 45263-1665
Phone (614) 831-0268

National Provider Directory

National Provider Directory
Tax ID family
Family First Vision Care Indiana LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1497125017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631665",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631665",
            "telephone_number": "614-831-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 COLDWATER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051113",
            "telephone_number": "260-483-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FIRST VISION CARE INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-25",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "JANDERNAL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "732-236-7067"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.