Provider Demographics
NPI:1740863109
Name:AVC OPTOMETRY INC
Entity type:Organization
Organization Name:AVC OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-327-3231
Mailing Address - Street 1:821 W HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1828
Mailing Address - Country:US
Mailing Address - Phone:618-464-0199
Mailing Address - Fax:844-682-0361
Practice Address - Street 1:821 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1828
Practice Address - Country:US
Practice Address - Phone:618-464-0199
Practice Address - Fax:844-682-0361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVC OPTOMETRY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty