Organization
FAMILY VISION CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN COUTS O.D. (PRESIDENT)
(574) 842-3372
Entity
Organization
Contact information
Practice address
202 N MAIN ST, CULVER, IN 46511-1516
(574) 842-3372
(574) 842-3390
Mailing address
202 N MAIN ST, CULVER, IN 46511-1516
(574) 842-3372
(574) 842-3390
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
18002062
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100279120A
—
IN
Enumeration date
05/16/2008
Last updated
03/25/2011
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