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General NPI Number Information
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NPI Number | 1457563892
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Entity Type | Organization
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Legal Business Name | AVON FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 5373 OBERLIN AVE
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City | LORAIN
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State | OH
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Zip | 44053-3437
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Country | US
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Telephone | 440-282-3670
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Fax | 866-423-6354
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Provider Business Mailing Address
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Address Line | 5373 OBERLIN AVE
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City | LORAIN
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State | OH
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Zip | 44053-3437
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Country | US
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Telephone | 440-282-3670
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Fax | 866-423-6354
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HUAN VIET PHAM
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Credential | OD
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Telephone | 440-282-3670
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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 | 5142
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License Number State | OH
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