MEDICARE: PERCEPTION VISION CARE

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1811544885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERCEPTION VISION CARE

Provider Business Mailing Address
First Line	:	11586 MURRAY AVE
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33778-2912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-2147
Country	:	US
Telephone Number	:	727-776-0136
Fax Number	:

Authorized Official
Title or Position	:	OD
Name	:	JENNIFER SCURLOCK
Credential	:	OD
Telephone Number	:	727-776-0136

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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Directions to “PERCEPTION VISION CARE ” Practice Location

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