Organization
VICTORY VISION PC
Active
Organization
VICTORY VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID ROSSELLO O.D. (PRESIDENT)
(215) 833-3465
Entity
Organization
Contact information
Practice address
3507 MANCHESTER EXPY, UNIT 92, COLUMBUS, GA 31909-6400
(706) 327-0111
(706) 327-4980
Mailing address
3507 MANCHESTER EXPY, UNIT 92, COLUMBUS, GA 31909-6400
(706) 327-0111
(706) 327-4980
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
GA 002439
GA
305R00000X
Preferred Provider Organization
GA 002439
GA
305S00000X
Point of Service
Primary
GA 002439
GA
Other
Enumeration date
06/29/2009
Last updated
07/15/2010
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