Provider Demographics
NPI:1174705438
Name:ADVANCED FAMILY EYECARE INC
Entity type:Organization
Organization Name:ADVANCED FAMILY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-367-2188
Mailing Address - Street 1:38661 PALMYRE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9284
Mailing Address - Country:US
Mailing Address - Phone:541-401-4649
Mailing Address - Fax:541-367-2189
Practice Address - Street 1:2245 LONG ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-2845
Practice Address - Country:US
Practice Address - Phone:541-367-2188
Practice Address - Fax:541-367-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2480ATI332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1C 4545640001OtherDMERC
1160810-1OtherBUSINESS ID NUMBER
OR046719Medicaid
OR212671OtherEYEMED VISION CARE ID NUM
ORR113193Medicare PIN
1160810-1OtherBUSINESS ID NUMBER
6238300001Medicare NSC