Provider Demographics
NPI:1508095357
Name:MAXIVISION, PC
Entity Type:Organization
Organization Name:MAXIVISION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASOD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-904-1900
Mailing Address - Street 1:4931 S. ROUTE 59
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-2692
Mailing Address - Country:US
Mailing Address - Phone:630-904-1900
Mailing Address - Fax:
Practice Address - Street 1:4931 S. ROUTE 59
Practice Address - Street 2:SUITE # 115
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-2692
Practice Address - Country:US
Practice Address - Phone:630-904-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82301Medicare UPIN
IL598800Medicare PIN