| Advanced Vision Care Center, Llc | |
|
100 Sycamore Estates Dr Aurora IN 47001 | |
| (812) 926-4836 | |
| (812) 926-4651 |
| Full Name | Advanced Vision Care Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Sycamore Estates Dr, Aurora, Indiana |
| Authorized Official Name and Position | Masoud Ghohestant (PRESIDENT) |
| Authorized Official Contact | 8129264836 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Vision Care Center, Llc Po Box 4174 Lawreneburg IN 47025-4174 Ph: (812) 926-4836 | Advanced Vision Care Center, Llc 100 Sycamore Estates Dr Aurora IN 47001 Ph: (812) 926-4836 |
| NPI Number | 1609829480 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 01/24/2024 |
| Medicare PECOS PAC ID | 6608805528 |
|---|---|
| Medicare Enrollment ID | O20050810000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609829480 | NPI | - | NPPES |
| 300024163 | Medicaid | IN | |
| 2278664 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Masoud Ghohestani |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1013961457 PECOS PAC ID: 4688603509 Enrollment ID: I20050810000826 |
| Provider Name | Keith W Blankman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1447382593 PECOS PAC ID: 4880777523 Enrollment ID: I20080219000088 |