Healthcare Provider Details

I. General information

NPI: 1760982656
Provider Name (Legal Business Name): FLORIDA VISION INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 SW INNOVATION WAY STE 101
PORT ST LUCIE FL
34987-2117
US

IV. Provider business mailing address

1050 SE MONTEREY RD STE 104
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 772-345-1500
  • Fax:
Mailing address:
  • Phone: 772-283-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: PRESIDENT
Credential:
Phone: 469-214-0144