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General NPI Number Information
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NPI Number | 1043561350
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Entity Type | Organization
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Legal Business Name | VISUAL HEALTH & LEARNING CENTER
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 12301 LAKE UNDERHILL RD SUITE 236
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City | ORLANDO
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State | FL
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Zip | 32828-4508
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Country | US
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Telephone | 407-277-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 12301 LAKE UNDERHILL RD SUITE 236
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City | ORLANDO
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State | FL
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Zip | 32828-4508
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Country | US
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Telephone | 407-277-5729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNA MCDERMED
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Credential | OS
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Telephone | 407-277-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPC4185
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License Number State | FL
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