Provider Demographics
NPI:1083159800
Name:AEVE, PA
Entity Type:Organization
Organization Name:AEVE, PA
Other - Org Name:ADVANCED EYECARE & VINTAGE EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-692-9596
Mailing Address - Street 1:4749 BUFFALO GAP RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3304
Mailing Address - Country:US
Mailing Address - Phone:325-692-9596
Mailing Address - Fax:325-690-6191
Practice Address - Street 1:4749 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3304
Practice Address - Country:US
Practice Address - Phone:325-692-9596
Practice Address - Fax:325-690-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8225-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty