Healthcare Provider Details

I. General information

NPI: 1649215104
Provider Name (Legal Business Name): BEACON VISION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 BICHARA BLVD
THE VILLAGES FL
32159-7716
US

IV. Provider business mailing address

1320 SHELFER ST
LEESBURY FL
34748-3929
US

V. Phone/Fax

Practice location:
  • Phone: 352-750-2414
  • Fax:
Mailing address:
  • Phone: 352-728-8318
  • Fax: 352-728-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2109
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN J. NAUMANN
Title or Position: CORP SEC
Credential: OPTICIAN
Phone: 352-728-8318