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General NPI Number Information
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NPI Number | 1356885933
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Entity Type | Organization
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Legal Business Name | CLEAR VISION LLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 8010 SUNPORT DR SUITE 115
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City | ORLANDO
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State | FL
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Zip | 32809-8112
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Country | US
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Telephone | 407-440-4822
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Fax | 407-440-8836
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Provider Business Mailing Address
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Address Line | 8010 SUNPORT DR SUITE 115
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City | ORLANDO
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State | FL
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Zip | 32809-8112
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Country | US
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Telephone | 407-440-4822
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Fax | 407-440-8836
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JIMMY NGUYEN
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Credential | O.D
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Telephone | 407-408-5177
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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 | OPC4478
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License Number State | FL
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