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General NPI Number Information
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NPI Number | 1760777346
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Entity Type | Organization
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Legal Business Name | ADVANCED OPTIX, LLC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 1310 E 79TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5768
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Country | US
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Telephone | 219-641-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 E 62ND PL
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City | HOBART
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State | IN
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Zip | 46342-6440
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Country | US
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Telephone | 773-663-6882
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JULIANA GROVE
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Credential | O.D.
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Telephone | 773-663-6882
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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 | 18003481A
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License Number State | IN
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