Organization
FAMILY FIRST VISION CARE INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE JANDERNAL (CREDENTIALING MANAGER)
(732) 236-7067
Entity
Organization
Contact information
Practice address
4201 COLDWATER RD, FORT WAYNE, IN 46805-1113
(260) 483-9568
Mailing address
PO BOX 631665, CINCINNATI, OH 45263-1665
(614) 831-0268
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
09/25/2015
Last updated
04/28/2023
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