MEDICARE: VANCE & TEKNIPP EYE CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5578	OH

General Provider Information

NPI Number	:	1013210053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANCE & TEKNIPP EYE CARE, LLC

Provider Business Mailing Address
First Line	:	602 SOUTH ST
Second Line	:	SUITE B-14
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	440-285-5007
Fax Number	:	440-285-4313

Provider Business Practice Location Address
First Line	:	602 SOUTH ST
Second Line	:	SUITE B-14
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	440-285-5007
Fax Number	:	440-285-4313

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. TRISHA BARNES VANCE
Credential	:	O.D.
Telephone Number	:	614-306-6294

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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