Organization
ROGER D. FANNIN, OD, PSC
Active
Other names
Family Vision Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER D. FANNIN OD (PRESIDENT)
(606) 474-7833
Entity
Organization
Contact information
Practice address
313 S CAROL MALONE BLVD, GRAYSON, KY 41143-1357
(606) 474-7833
(606) 474-3563
Mailing address
313 S CAROL MALONE BLVD, PO BOX 485, GRAYSON, KY 41143-1357
(606) 474-7833
(606) 474-3563
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1018DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77901023
—
KY
01
—
DA4435
RR MEDICARE
KY
Enumeration date
05/31/2007
Last updated
04/14/2023
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