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General NPI Number Information
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NPI Number | 1043753320
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Entity Type | Organization
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Legal Business Name | PRO VISION EYE CARE CENTER, INC
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 16359 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33027-4571
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Country | US
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Telephone | 954-517-9041
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Fax | 954-517-9073
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Provider Business Mailing Address
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Address Line | 16359 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33027-4571
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Country | US
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Telephone | 954-517-9041
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Fax | 954-517-9073
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESUS CUEVAS
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Credential | O.D.
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Telephone | 954-517-9041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4122
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License Number State | FL
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