Provider Demographics
NPI:1689917957
Name:ADVANCED OPTIX LLC
Entity Type:Organization
Organization Name:ADVANCED OPTIX LLC
Other - Org Name:21 NORTH EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-663-6882
Mailing Address - Street 1:21 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4778
Mailing Address - Country:US
Mailing Address - Phone:219-286-7007
Mailing Address - Fax:
Practice Address - Street 1:21 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4778
Practice Address - Country:US
Practice Address - Phone:219-286-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003481A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty