=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669718607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION MARKETPLACE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2012
-----------------------------------------------------
Last Update Date | 12/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2129 SW HIGHWAY 484
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34473-7949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-347-2710
-----------------------------------------------------
Fax | 352-347-9130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2129 SW HIGHWAY 484
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34473-7949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-347-2710
-----------------------------------------------------
Fax | 352-347-9130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN DAVID PALMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-364-1610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | OE1326
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------