Healthcare Provider Details

I. General information

NPI: 1083614366
Provider Name (Legal Business Name): FLORIDA VISION INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 947665
ATLANTA GA
30394-7665
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-2020
  • Fax: 772-220-9582
Mailing address:
  • Phone: 772-283-2020
  • Fax: 772-220-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL

VIII. Authorized Official

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