MEDICARE: ADVANCE VISION EYE CARE, S.C.

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	207W00000X	Ophthalmology Physician	036101730	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	042618472	OTHER		CORPORATION LICENSE

General Provider Information

NPI Number	:	1861500555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE VISION EYE CARE, S.C.

Provider Business Mailing Address
First Line	:	1770 E LAKE SHORE DRIVE
Second Line	:	SUITE 101
City	:	DECATUR
State	:	IL
Zip	:	62521-3886
Country	:	US
Telephone Number	:	217-233-1405
Fax Number	:	217-233-1407

Provider Business Practice Location Address
First Line	:	1770 E LAKE SHORE DR
Second Line	:	SUITE 101
City	:	DECATUR
State	:	IL
Zip	:	62521-3886
Country	:	US
Telephone Number	:	217-233-1405
Fax Number	:	217-233-1407

Authorized Official
Title or Position	:	MEDICAL DOCTOR/ OPHTHALMOLOGIST
Name	:	DR. MAUNG MAUNG TIN
Credential	:	MD
Telephone Number	:	217-233-1405

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/06/2009

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