Provider Demographics
NPI:1992998637
Name:ADVANCED VISION, LLC
Entity type:Organization
Organization Name:ADVANCED VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHBA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-447-2020
Mailing Address - Street 1:4200 MERCHANT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5816
Mailing Address - Country:US
Mailing Address - Phone:573-447-2020
Mailing Address - Fax:573-447-2042
Practice Address - Street 1:4200 MERCHANT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5816
Practice Address - Country:US
Practice Address - Phone:573-447-2020
Practice Address - Fax:573-447-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty