Healthcare Provider Details

I. General information

NPI: 1295843993
Provider Name (Legal Business Name): VISUAL HEALTH & SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROSEMARY AVENUE #103
WEST PALM BEACH FL
33401
US

IV. Provider business mailing address

2889 10TH AVENUE NORTH STE 305
LAKE WORTH FL
33461
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-2299
  • Fax: 561-964-8164
Mailing address:
  • Phone: 561-964-0707
  • Fax: 561-964-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SONDRA STATEMENT
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-964-0707