Organization
ADVANCED FAMILY EYECARE OF TRUMBULL CO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY KAPPAS (OFFICE MANAGER)
(330) 856-6113
Entity
Organization
Contact information
Practice address
8252 HIGH ST NE, WARREN, OH 44484-1923
(330) 856-6113
(330) 856-6437
Mailing address
8252 HIGH ST NE, WARREN, OH 44484-1923
(330) 856-6113
(330) 856-6437
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4851T1716
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2594590
—
OH
Enumeration date
07/20/2007
Last updated
05/04/2012
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