Healthcare Provider Details

I. General information

NPI: 1336306646
Provider Name (Legal Business Name): VISION MAGIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 BEVILLE RD
DAYTONA BEACH FL
32119-1529
US

IV. Provider business mailing address

1369 BEVILLE RD
DAYTONA BEACH FL
32119-1529
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-2020
  • Fax: 386-761-8210
Mailing address:
  • Phone: 386-767-2020
  • Fax: 386-761-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO2818
License Number StateFL

VIII. Authorized Official

Name: MR. HARRY ROWLEY
Title or Position: OWNER
Credential: D.O.
Phone: 386-767-2020