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General NPI Number Information
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NPI Number | 1053532929
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Entity Type | Organization
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Legal Business Name | ADVANCED VISION CARE PA
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 223 1ST ST E STE 101
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City | JORDAN
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State | MN
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Zip | 55352-1563
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Country | US
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Telephone | 952-492-2350
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Fax | 952-492-6162
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Provider Business Mailing Address
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Address Line | 223 1ST ST E STE 101
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City | JORDAN
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State | MN
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Zip | 55352-1563
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Country | US
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Telephone | 952-492-2350
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Fax | 952-492-6162
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Authorized Official
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Title or Position | OPTOMETRIST /CO-OWNER
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Name | DR. VICKI S LUEHMANN
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Credential | OD
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Telephone | 952-492-2350
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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 | 2848
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License Number State | MN
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