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General NPI Number Information
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NPI Number | 1043896061
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Entity Type | Organization
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Legal Business Name | EYELLIANCE VISION PARTNERS ASC LLC
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Dates
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Enumeration Date | 03/20/2021
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 800 TRANCAS ST
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City | NAPA
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State | CA
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Zip | 94558-3044
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Country | US
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Telephone | 314-265-5663
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Fax |
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Provider Business Mailing Address
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Address Line | 17712 BIRCH LEAF CT
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City | WILDWOOD
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State | MO
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Zip | 63005-4277
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Country | US
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Telephone | 314-265-5663
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS - ASCS
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Name | JESSICA GREENE
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Credential |
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Telephone | 913-940-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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