Provider Demographics
NPI:1043488547
Name:ADVANCED FAMILY VISION CENTER INC
Entity type:Organization
Organization Name:ADVANCED FAMILY VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-524-1254
Mailing Address - Street 1:766 LOS ANGELES AVE
Mailing Address - Street 2:SUITE D3
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:766 LOS ANGELES AVE
Practice Address - Street 2:SUITE D3
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021
Practice Address - Country:US
Practice Address - Phone:805-624-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty