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General NPI Number Information
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NPI Number | 1710394085
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Entity Type | Organization
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Legal Business Name | VISIONS UNLIMITED OPHTHALMIC, LLC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 1850 BOY SCOUT DR UNIT 107
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City | FORT MYERS
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State | FL
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Zip | 33907-2127
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Country | US
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Telephone | 239-931-0136
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Fax | 239-931-0910
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Provider Business Mailing Address
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Address Line | 1850 BOY SCOUT DR UNIT 107
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City | FORT MYERS
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State | FL
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Zip | 33907-2127
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Country | US
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Telephone | 239-931-0136
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Fax | 239-931-0910
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RICHARD W. MCCOY
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Credential | LDO
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Telephone | 239-931-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OE 2124
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License Number State | FL
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