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General NPI Number Information
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NPI Number | 1073911756
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Entity Type | Organization
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Legal Business Name | PRECISION VISION CORPORATION
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 1500 REISTERSTOWN RD SUITE 208
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City | PIKESVILLE
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State | MD
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Zip | 21208-4339
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Country | US
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Telephone | 410-653-2400
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Fax | 410-653-2402
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Provider Business Mailing Address
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Address Line | 1500 REISTERSTOWN RD SUITE 208
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City | PIKESVILLE
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State | MD
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Zip | 21208-4339
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Country | US
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Telephone | 410-653-2400
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Fax | 410-653-2402
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SELVIN GNANAKKAN
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Credential | OD
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Telephone | 602-770-9300
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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 | 1127
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1769
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1769
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License Number State | MD
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