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General NPI Number Information
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NPI Number | 1336348804
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Entity Type | Organization
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Legal Business Name | ADVANCED VISION CARE DOCTORS, LLC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 2305 MAPLE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2028
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Country | US
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Telephone | 614-453-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 MAPLE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2028
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Country | US
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Telephone | 614-453-5200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYLA COLOGGI
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Credential | OD
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Telephone | 614-898-9989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | SC 549
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License Number State | OH
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