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General NPI Number Information
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NPI Number | 1215470836
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Entity Type | Organization
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Legal Business Name | PRECISION VISION AZ LLC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 4000 OLD COURT RD SUITE 204
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City | PIKESVILLE
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State | MD
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Zip | 21208-2800
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Country | US
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Telephone | 410-653-2400
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Fax | 602-535-3165
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Provider Business Mailing Address
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Address Line | 1135 REGINA DR
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City | HALETHORPE
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State | MD
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Zip | 21227-2342
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Country | US
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Telephone | 410-653-2400
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Fax | 602-535-3165
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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