Provider Demographics
NPI:1609292762
Name:ADVANCED VISION LLC
Entity Type:Organization
Organization Name:ADVANCED VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-259-5100
Mailing Address - Street 1:4998 STATE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4626
Mailing Address - Country:US
Mailing Address - Phone:610-259-5100
Mailing Address - Fax:610-259-4133
Practice Address - Street 1:4998 STATE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4626
Practice Address - Country:US
Practice Address - Phone:610-259-5100
Practice Address - Fax:610-259-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty