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General NPI Number Information
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NPI Number | 1497340368
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Entity Type | Organization
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Legal Business Name | ADVANCED VISION LLC
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 13921 S VIRGINIA ST STE 116
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City | RENO
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State | NV
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Zip | 89511-2911
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Country | US
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Telephone | 775-826-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 5465 MEADOWOOD MALL CIR
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City | RENO
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State | NV
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Zip | 89502-6710
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Country | US
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Telephone | 775-826-4100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY BECK
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Credential | OD
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Telephone | 512-900-0322
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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 |
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License Number State |
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