Healthcare Provider Details

I. General information

NPI: 1396053237
Provider Name (Legal Business Name): DV EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 HOFFNER AVE
ORLANDO FL
32812-2331
US

IV. Provider business mailing address

4413 HOFFNER AVE
ORLANDO FL
32812-2331
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-5310
  • Fax:
Mailing address:
  • Phone: 407-207-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3789
License Number StateFL

VIII. Authorized Official

Name: DR. VINCENT MINH DO
Title or Position: MEMBER
Credential: O.D.
Phone: 407-207-5310