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General NPI Number Information
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NPI Number | 1447696018
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Entity Type | Organization
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Legal Business Name | VITRECTOMY RECOVERY EQUIPMENT
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 1509 W WINDY WILLOW DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5094
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Country | US
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Telephone | 904-230-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 W WINDY WILLOW DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5094
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Country | US
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Telephone | 904-230-5400
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CARL EUGENE BOX
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Credential |
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Telephone | 904-230-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | FL
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