Provider Demographics
NPI:1255466546
Name:COMMUNITY VISION CENTERS INC
Entity Type:Organization
Organization Name:COMMUNITY VISION CENTERS INC
Other - Org Name:AUGUST OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:KRYMIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:269-345-4425
Mailing Address - Street 1:4425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2648
Mailing Address - Country:US
Mailing Address - Phone:269-345-4425
Mailing Address - Fax:269-345-4435
Practice Address - Street 1:4425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2648
Practice Address - Country:US
Practice Address - Phone:269-345-4425
Practice Address - Fax:269-345-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5052968Medicaid
MIU08629Medicare UPIN
MI5052968Medicaid
MI0M98520Medicare ID - Type Unspecified