Provider Demographics
NPI:1437748563
Name:ADVANCED VISION LLC
Entity Type:Organization
Organization Name:ADVANCED VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-900-0322
Mailing Address - Street 1:3323 PINE NEEDLE CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1147
Mailing Address - Country:US
Mailing Address - Phone:512-900-0322
Mailing Address - Fax:
Practice Address - Street 1:5465 MEADOWOOD MALL CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6710
Practice Address - Country:US
Practice Address - Phone:775-391-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770622045OtherNPI
NV1055OtherNEVADA BOARD OF OPTOMETRY