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General NPI Number Information
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NPI Number | 1154561546
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Entity Type | Organization
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Legal Business Name | ENVISION EYE SPECIALISTS, LLC
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 3200 SW 34TH AVE STE 201
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City | OCALA
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State | FL
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Zip | 34474-7408
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Country | US
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Telephone | 216-338-7773
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Fax | 352-482-0311
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Provider Business Mailing Address
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Address Line | 3200 SW 34TH AVE STE 201
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City | OCALA
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State | FL
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Zip | 34474-7408
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Country | US
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Telephone | 216-338-7773
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Fax | 352-482-0311
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH J ROSS
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Credential | MD
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Telephone | 216-338-7773
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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