Provider Demographics
NPI:1144372103
Name:AURORA VISION GROUP, P.C.
Entity type:Organization
Organization Name:AURORA VISION GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-224-2306
Mailing Address - Street 1:2567 HOUSLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6751
Mailing Address - Country:US
Mailing Address - Phone:410-224-2306
Mailing Address - Fax:410-224-0206
Practice Address - Street 1:2567 HOUSLEY RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6751
Practice Address - Country:US
Practice Address - Phone:410-224-2306
Practice Address - Fax:410-224-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA-1003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU16798Medicare UPIN
MD622MMedicare PIN