Provider Demographics
NPI:1053459552
Name:APPLE VALLEY VISION CENTER, PLLC
Entity Type:Organization
Organization Name:APPLE VALLEY VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-879-0256
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3191
Mailing Address - Country:US
Mailing Address - Phone:802-879-0256
Mailing Address - Fax:802-879-2401
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3191
Practice Address - Country:US
Practice Address - Phone:802-879-0256
Practice Address - Fax:802-879-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty