Healthcare Provider Details

I. General information

NPI: 1356697064
Provider Name (Legal Business Name): MOBILE VISION DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SILK OAK DR
HOLLYWOOD FL
33021-1367
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: 305-503-9250
Mailing address:
  • Phone: 305-439-2015
  • Fax: 305-503-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC3957
License Number StateFL

VIII. Authorized Official

Name: DR. RYAN CARLO VERXAGIO
Title or Position: OWNER/MANAGER
Credential: O.D.
Phone: 305-439-2015