Healthcare Provider Details

I. General information

NPI: 1134740319
Provider Name (Legal Business Name): VISION ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9726 TOUCHTON RD STE 305
JACKSONVILLE FL
32246-8307
US

IV. Provider business mailing address

PO BOX 4485 DEPT 1200
HOUSTON TX
77210-4485
US

V. Phone/Fax

Practice location:
  • Phone: 904-686-6020
  • Fax: 904-619-8879
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KIRBY KITCHENS
Title or Position: MEMBER/MANAGER
Credential: CRNA
Phone: 941-360-1566