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General NPI Number Information
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NPI Number | 1386821379
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Entity Type | Organization
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Legal Business Name | FAMILY VISION INSTITUTE OF SOUTH FLORIDA INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 640 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-4686
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Country | US
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Telephone | 954-522-3918
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Fax | 954-522-5137
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Provider Business Mailing Address
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Address Line | 640 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-4686
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Country | US
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Telephone | 954-522-3918
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Fax | 954-522-5137
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Authorized Official
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Title or Position | CEO
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Name | DR. BRANDON WILLIAM CORNISH
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Credential | O.D.
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Telephone | 954-522-3918
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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 | OPC4217
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License Number State | FL
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