Healthcare Provider Details

I. General information

NPI: 1376141754
Provider Name (Legal Business Name): AA VISION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 SE BURNSIDE RD
GRESHAM OR
97080-1247
US

IV. Provider business mailing address

2474 SE BURNSIDE RD
GRESHAM OR
97080-1247
US

V. Phone/Fax

Practice location:
  • Phone: 503-484-8663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANTHONY J TURIN
Title or Position: OWNER/DOCTOR
Credential: OD
Phone: 503-484-8663