Basic Information
| Provider Information | |||||||||
| NPI: | 1588216568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CVS AOC CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CVS DR | ||||||||
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| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028956195 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10011 ADAMS AVE # 9483 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926464904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148452002 | ||||||||
| FaxNumber: | 7143793304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEA | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4013742519 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.