Provider Demographics
NPI:1073911756
Name:PRECISION VISION CORPORATION
Entity Type:Organization
Organization Name:PRECISION VISION CORPORATION
Other - Org Name:PRECISION VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANAKKAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-770-9300
Mailing Address - Street 1:1500 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4339
Mailing Address - Country:US
Mailing Address - Phone:410-653-2400
Mailing Address - Fax:410-653-2402
Practice Address - Street 1:1500 REISTERSTOWN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4339
Practice Address - Country:US
Practice Address - Phone:410-653-2400
Practice Address - Fax:410-653-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1769152W00000X, 152WC0802X
AZ1127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031847700Medicaid
MD031847700Medicaid