Healthcare Provider Details

I. General information

NPI: 1174160972
Provider Name (Legal Business Name): CASE VISION ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2019
Last Update Date: 11/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 W GRANADA BLVD STE 470
ORMOND BEACH FL
32174-8240
US

IV. Provider business mailing address

2564 ENTERPRISE RD
ORANGE CITY FL
32763-7904
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-3011
  • Fax: 386-673-3099
Mailing address:
  • Phone: 386-774-7242
  • Fax: 386-774-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MICHAEL CASE
Title or Position: OWNER
Credential: OD
Phone: 386-673-3011