Healthcare Provider Details

I. General information

NPI: 1558127977
Provider Name (Legal Business Name): CRESTVIEW VISION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S FERDON BLVD STE B
CRESTVIEW FL
32536-4446
US

IV. Provider business mailing address

535 S FERDON BLVD STE B
CRESTVIEW FL
32536-4446
US

V. Phone/Fax

Practice location:
  • Phone: 850-331-3918
  • Fax: 850-634-6127
Mailing address:
  • Phone: 850-331-3918
  • Fax: 850-634-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DAVID COX
Title or Position: MANAGER
Credential: DO
Phone: 503-313-9188