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General NPI Number Information
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NPI Number | 1710336961
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Entity Type | Organization
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Legal Business Name | VAN EYE OPTOMETRY
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 9982 GLADES RD SUITE G1
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City | BOCA RATON
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State | FL
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Zip | 33434-3913
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Country | US
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Telephone | 561-558-9965
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Fax | 561-558-9512
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Provider Business Mailing Address
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Address Line | 9982 GLADES RD SUITE G1
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City | BOCA RATON
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State | FL
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Zip | 33434-3913
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Country | US
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Telephone | 561-558-9965
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Fax | 561-558-9512
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD Q VAN
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Credential | OD
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Telephone | 561-558-9965
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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 | OPC4689
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License Number State | FL
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