Provider Demographics
NPI:1861500555
Name:ADVANCE VISION EYE CARE, S.C.
Entity Type:Organization
Organization Name:ADVANCE VISION EYE CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/ OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUNG
Authorized Official - Middle Name:MAUNG
Authorized Official - Last Name:TIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-233-1405
Mailing Address - Street 1:1770 E LAKE SHORE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3886
Mailing Address - Country:US
Mailing Address - Phone:217-233-1405
Mailing Address - Fax:217-233-1407
Practice Address - Street 1:1770 E LAKE SHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3886
Practice Address - Country:US
Practice Address - Phone:217-233-1405
Practice Address - Fax:217-233-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101730Medicaid
042618472OtherCORPORATION LICENSE
200846Medicare ID - Type Unspecified
042618472OtherCORPORATION LICENSE