Healthcare Provider Details

I. General information

NPI: 1164676748
Provider Name (Legal Business Name): AVON VISION ENHANCEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E. GARNER RD. SUITE A
BROWNSBURG IN
46112-9360
US

IV. Provider business mailing address

90 E. GARNER RD. SUITE A
BROWNSBURG IN
46112-9360
US

V. Phone/Fax

Practice location:
  • Phone: 317-858-7900
  • Fax: 317-858-7990
Mailing address:
  • Phone: 317-858-7900
  • Fax: 317-858-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003213A
License Number StateIN

VIII. Authorized Official

Name: DR. AMANDA ELAINE JUDSON
Title or Position: OWNER/OPTOMETRIST
Credential: O.D., M.S., FCOVD
Phone: 317-858-7900