Provider Demographics
NPI:1265255608
Name:AMERICAN VISION LAB INC
Entity type:Organization
Organization Name:AMERICAN VISION LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:SLD, RDO
Authorized Official - Phone:818-830-5900
Mailing Address - Street 1:9051 VAN NUYS BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1858
Mailing Address - Country:US
Mailing Address - Phone:818-830-5900
Mailing Address - Fax:818-830-5975
Practice Address - Street 1:9051 VAN NUYS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1858
Practice Address - Country:US
Practice Address - Phone:818-830-5900
Practice Address - Fax:818-830-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier