Healthcare Provider Details

I. General information

NPI: 1588487458
Provider Name (Legal Business Name): VISION DOCTORS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 TREASURE COVE CIR
FORT LAUDERDALE FL
33312-5605
US

IV. Provider business mailing address

1315 SILK OAK DR
HOLLYWOOD FL
33021-1367
US

V. Phone/Fax

Practice location:
  • Phone: 305-439-2015
  • Fax:
Mailing address:
  • Phone: 305-439-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RYAN C VERXAGIO
Title or Position: OWNER
Credential: OD
Phone: 305-439-2015