Provider Demographics
NPI:1992748370
Name:AMERICAN VISION ASSOCIATES, LLC
Entity type:Organization
Organization Name:AMERICAN VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAILENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-7401
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-0188
Mailing Address - Country:US
Mailing Address - Phone:781-729-7401
Mailing Address - Fax:781-729-5160
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-729-7401
Practice Address - Fax:781-729-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159572156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9745980Medicaid
MAG95448Medicare UPIN
MA0005762Medicare PIN