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General NPI Number Information
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NPI Number | 1376677971
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Entity Type | Organization
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Legal Business Name | ADVANCED FOCUS VISION CENTER LTD.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 24735 W EAMES ST SUITE 11
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City | CHANNAHON
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State | IL
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Zip | 60410-8705
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Country | US
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Telephone | 815-467-0077
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Fax | 815-467-0088
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Provider Business Mailing Address
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Address Line | 24735 W EAMES ST SUITE 11
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City | CHANNAHON
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State | IL
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Zip | 60410-8705
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Country | US
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Telephone | 815-467-0077
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Fax | 815-467-0088
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Authorized Official
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Title or Position | OPTOMETRIST PRESIDENT
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Name | DR. BRIAN BOUTON
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Credential | O.D.
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Telephone | 815-467-0077
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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 | 046-009118
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License Number State | IL
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