Provider Demographics
NPI:1174677959
Name:AVERY VISION CENTER PC
Entity Type:Organization
Organization Name:AVERY VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:989-224-3937
Mailing Address - Street 1:1002 N US 27
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879
Mailing Address - Country:US
Mailing Address - Phone:989-224-3937
Mailing Address - Fax:989-224-4999
Practice Address - Street 1:1002 N US 27
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879
Practice Address - Country:US
Practice Address - Phone:989-224-3937
Practice Address - Fax:989-224-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0365160001Medicare PIN