Provider Demographics
NPI:1194139972
Name:ADVANCED FAMILY VISION CARE, LLC
Entity type:Organization
Organization Name:ADVANCED FAMILY VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-351-8079
Mailing Address - Street 1:331 GAMBRILLS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1141
Mailing Address - Country:US
Mailing Address - Phone:443-351-8079
Mailing Address - Fax:
Practice Address - Street 1:331 GAMBRILLS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1141
Practice Address - Country:US
Practice Address - Phone:443-351-8079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218704YBP8Medicare PIN