Provider Demographics
NPI:1457563892
Name:AVON FAMILY EYECARE, LLC
Entity Type:Organization
Organization Name:AVON FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HUAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-934-3770
Mailing Address - Street 1:36941 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1517
Mailing Address - Country:US
Mailing Address - Phone:440-934-3770
Mailing Address - Fax:866-423-6354
Practice Address - Street 1:36941 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1517
Practice Address - Country:US
Practice Address - Phone:440-934-3770
Practice Address - Fax:866-423-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAV9335321Medicare ID - Type UnspecifiedGROUP MEDICARE