Provider Demographics
NPI:1841579729
Name:AECC TOTAL VISION HEALTH PLAN OF TEXAS, INC.
Entity Type:Organization
Organization Name:AECC TOTAL VISION HEALTH PLAN OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-334-3937
Mailing Address - Street 1:PO BOX 7548
Mailing Address - Street 2:112 ZEBULON COURT
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2420
Mailing Address - Country:US
Mailing Address - Phone:800-334-3937
Mailing Address - Fax:252-451-2928
Practice Address - Street 1:112 ZEBULON COURT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2420
Practice Address - Country:US
Practice Address - Phone:800-334-3937
Practice Address - Fax:252-451-2928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENCORP HEALTH SOLUTIONS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28-094478302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization