Provider Demographics
NPI:1902459290
Name:AW VISION, PLLC
Entity Type:Organization
Organization Name:AW VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-427-9620
Mailing Address - Street 1:39885 GRAND RIVER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2150
Mailing Address - Country:US
Mailing Address - Phone:248-427-9620
Mailing Address - Fax:248-427-9610
Practice Address - Street 1:39885 GRAND RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2150
Practice Address - Country:US
Practice Address - Phone:248-427-9620
Practice Address - Fax:248-427-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty