MEDICARE: MAXIMEYES VISION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1083123418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIMEYES VISION, INC.

Provider Business Mailing Address
First Line	:	7501 CITRUS AVE UNIT 652
Second Line	:
City	:	GOLDENROD
State	:	FL
Zip	:	32733-5527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S ORANGE BLOSSOM TRAIL
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703
Country	:	US
Telephone Number	:	407-553-4105
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOELLE RODRIGUEZ
Credential	:
Telephone Number	:	407-773-5111

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	03/17/2018

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Directions to “MAXIMEYES VISION, INC. ” Practice Location

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