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General NPI Number Information
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NPI Number | 1043488547
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY VISION CENTER INC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 766 LOS ANGELES AVE SUITE D3
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City | MOORPARK
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State | CA
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Zip | 93021
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Country | US
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Telephone | 805-624-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 766 LOS ANGELES AVE SUITE D3
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City | MOORPARK
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State | CA
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Zip | 93021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST-OWNER
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Name | DR. KIMBERLY ANN TEDDER
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Credential | OD
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Telephone | 805-524-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13135
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License Number State | CA
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