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General NPI Number Information
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NPI Number | 1841579729
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Entity Type | Organization
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Legal Business Name | AECC TOTAL VISION HEALTH PLAN OF TEXAS, INC.
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 112 ZEBULON COURT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2420
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Country | US
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Telephone | 800-334-3937
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Fax | 252-451-2928
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Provider Business Mailing Address
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Address Line | PO BOX 7548 112 ZEBULON COURT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2420
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Country | US
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Telephone | 800-334-3937
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Fax | 252-451-2928
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID M. LAVELY
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Credential |
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Telephone | 800-334-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 28-094478
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License Number State | TX
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