Organization
PRECISION VISION AZ LLC
Active
Parent organization
SOUTH MOUNTAIN EYECARE
Other names
Precision Vision
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH MOUNTAIN EYECARE
Authorized official
DR. SELVIN GNANAKKAN OD (OPTOMETRIST/PRESIDENT)
(602) 770-9300
Entity
Organization
Contact information
Practice address
4000 OLD COURT RD, SUITE 204, PIKESVILLE, MD 21208-2800
(410) 653-2400
(602) 535-3165
Mailing address
1135 REGINA DR, HALETHORPE, MD 21227-2342
(410) 653-2400
(602) 535-3165
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Enumeration date
11/30/2016
Last updated
11/30/2016
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