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General NPI Number Information
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NPI Number | 1649215104
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Entity Type | Organization
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Legal Business Name | BEACON VISION CENTER, INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 1128 BICHARA BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32159-7716
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Country | US
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Telephone | 352-750-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 SHELFER ST
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City | LEESBURY
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State | FL
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Zip | 34748-3929
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Country | US
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Telephone | 352-728-8318
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Fax | 352-728-0057
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Authorized Official
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Title or Position | CORP SEC
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Name | MR. JOHN J. NAUMANN
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Credential | OPTICIAN
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Telephone | 352-728-8318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 2109
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License Number State | FL
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Taxonomy #2
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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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