Provider Demographics
NPI:1043420508
Name:ADVANCED VISION OF IRONTON LLC
Entity Type:Organization
Organization Name:ADVANCED VISION OF IRONTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-533-3934
Mailing Address - Street 1:307 MADISON ST.
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1638
Mailing Address - Country:US
Mailing Address - Phone:740-533-3934
Mailing Address - Fax:
Practice Address - Street 1:307 MADISON ST.
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1638
Practice Address - Country:US
Practice Address - Phone:740-533-3934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF9331Medicare UPIN
OH6895720001Medicare NSC
OHAD9368531Medicare PIN