Provider Demographics
NPI:1821326554
Name:ADVANCED VISUAL LEARNING CENTER
Entity Type:Organization
Organization Name:ADVANCED VISUAL LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:517-545-2020
Mailing Address - Street 1:4201 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6500
Mailing Address - Country:US
Mailing Address - Phone:517-545-2020
Mailing Address - Fax:517-545-2002
Practice Address - Street 1:4201 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6500
Practice Address - Country:US
Practice Address - Phone:517-545-2020
Practice Address - Fax:517-545-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty