Provider Demographics
NPI:1548492903
Name:ADVANCED VISION CARE, P.C.
Entity type:Organization
Organization Name:ADVANCED VISION CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-434-8617
Mailing Address - Street 1:590 32 RD # 3C
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7621
Mailing Address - Country:US
Mailing Address - Phone:970-434-8617
Mailing Address - Fax:970-434-8618
Practice Address - Street 1:590 32 RD # 3C
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7621
Practice Address - Country:US
Practice Address - Phone:970-434-8617
Practice Address - Fax:970-434-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4915Medicare PIN