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General NPI Number Information
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NPI Number | 1568769701
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Entity Type | Organization
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Legal Business Name | CAPITAL VISION CARE INC.
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 11401 PINES BLVD SUITE 352
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4117
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Country | US
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Telephone | 954-438-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 13210 SW 19TH DR
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City | MIRAMAR
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State | FL
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Zip | 33027-3431
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Country | US
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Telephone | 305-490-0326
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELODY LEON
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Credential | O.D.
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Telephone | 305-490-0326
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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 | OPC4243
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License Number State | FL
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