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General NPI Number Information
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NPI Number | 1508049925
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Entity Type | Organization
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Legal Business Name | VISIONARY OPTOMETRY INC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 1941 MICHIGAN AVE
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City | COCOA
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State | FL
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Zip | 32922-5728
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Country | US
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Telephone | 321-638-3931
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Fax |
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Provider Business Mailing Address
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Address Line | 1941 MICHIGAN AVE
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City | COCOA
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State | FL
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Zip | 32922-5728
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Country | US
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Telephone | 321-638-3931
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | MICAH R GIRARD
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Credential | OD
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Telephone | 321-638-3931
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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 | OPC 3800
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License Number State | FL
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