Healthcare Provider Details

I. General information

NPI: 1013445956
Provider Name (Legal Business Name): EYE CARE VISION GROUP P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3382 NW FEDERAL HWY
JENSEN BEACH FL
34957-4404
US

IV. Provider business mailing address

3382 NW FEDERAL HWY
JENSEN BEACH FL
34957-4404
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1090
  • Fax: 772-286-1214
Mailing address:
  • Phone: 772-286-1090
  • Fax: 772-286-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2430
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARLINGTON HANNA JR.
Title or Position: DOCTOR
Credential: OD
Phone: 772-286-1090