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General NPI Number Information
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NPI Number | 1861500555
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Entity Type | Organization
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Legal Business Name | ADVANCE VISION EYE CARE, S.C.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 1770 E LAKE SHORE DR SUITE 101
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City | DECATUR
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State | IL
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Zip | 62521-3886
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Country | US
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Telephone | 217-233-1405
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Fax | 217-233-1407
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Provider Business Mailing Address
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Address Line | 1770 E LAKE SHORE DRIVE SUITE 101
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City | DECATUR
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State | IL
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Zip | 62521-3886
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Country | US
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Telephone | 217-233-1405
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Fax | 217-233-1407
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Authorized Official
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Title or Position | MEDICAL DOCTOR/ OPHTHALMOLOGIST
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Name | DR. MAUNG MAUNG TIN
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Credential | MD
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Telephone | 217-233-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036101730
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License Number State | IL
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