Healthcare Provider Details

I. General information

NPI: 1114268794
Provider Name (Legal Business Name): VISION EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ARLINGTON EXPRESSWAY #340
JACKSONVILLE FL
32225-8209
US

IV. Provider business mailing address

14964 MAX LEGGETT PARKWAY #106
JACKSONVILLE FL
32218-7235
US

V. Phone/Fax

Practice location:
  • Phone: 904-418-8339
  • Fax: 904-701-9507
Mailing address:
  • Phone: 904-418-8339
  • Fax: 904-701-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. ALLISON A FALDEN
Title or Position: PHYSICIAN
Credential: OD
Phone: 904-418-8339