=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568608891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED VISION CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2008
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2710 E AIRLINE RD
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-485-9421
-----------------------------------------------------
Fax | 361-485-9422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2710 E AIRLINE RD
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-485-9421
-----------------------------------------------------
Fax | 361-485-9422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VALERIE LYN BAKER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 361-485-9421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7280TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------