NPIMap

Organization Active NPI

Family First Vision Care Indiana LLC

  • Optometrist
  • Mishawaka, IN
National Provider Identifier
1922525427
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY FIRST VISION CARE INDIANA LLC
Practice address
6502 Grape Rd
Mishawaka, IN 46545-1102
Phone
(574) 227-7723
Fax
(574) 227-7723
NPI assigned
Aug 24, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Ryan Williams
Title
Coo
Phone
(904) 545-4465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

6502 Grape Rd
Mishawaka, IN 46545-1102

Mailing address

4680 Parkway Dr Ste 455
Mason, OH 45040-8199
Phone (513) 445-9064

Other practice location 1

4201 Coldwater Rd
Fort Wayne, IN 46805-1113
Phone (260) 683-9568

Other practice location 2

3024 E 3rd St # Lo5C
Bloomington, IN 47401-5425
Phone (812) 332-9014

Other practice location 3

4024 Elkhart Rd Ste 23
Goshen, IN 46526-5803
Phone (574) 875-5042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180321002187 IN Part B Supplier - Clinic/Group Practice 1557623063 Receives reassigned benefits from 16 practitioners
Practice locations: Fort Wayne, IN; Mishawaka, IN; Goshen, IN

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.

Locations

3024 E 3rd St
Bloomington, IN 47401
Phone (812) 330-2900

3024 E 3rd St
#5C
Bloomington, IN 47401
Phone (812) 332-9014

4150 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 483-9568

4024 Elkhart Rd
Ste 23
Goshen, IN 46526
Phone (574) 875-5042

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1922525427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4680 PARKWAY DR STE 455",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450408199",
            "telephone_number": "513-445-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 GRAPE RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451102",
            "telephone_number": "574-227-7723",
            "fax_number": "574-227-7723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Coldwater Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468051113",
            "country_code": "US",
            "telephone_number": "260-683-9568",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3024 E 3rd St # Lo5C",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474015425",
            "country_code": "US",
            "telephone_number": "812-332-9014",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4024 Elkhart Rd Ste 23",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465265803",
            "country_code": "US",
            "telephone_number": "574-875-5042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY FIRST VISION CARE INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "904-545-4465"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.