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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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