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General NPI Number Information
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NPI Number | 1861859571
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Entity Type | Organization
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Legal Business Name | IMPERIAL VISION CENTER, INC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 19605 STATE ROAD 7 STE D
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City | BOCA RATON
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State | FL
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Zip | 33498-4767
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Country | US
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Telephone | 561-451-0524
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Fax | 561-451-0788
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Provider Business Mailing Address
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Address Line | 19605 STATE ROAD 7 STE D
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City | BOCA RATON
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State | FL
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Zip | 33498-4767
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Country | US
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Telephone | 561-451-0524
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Fax | 561-451-0788
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Authorized Official
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Title or Position | OPOMETRIST/ OWNER
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Name | DR. RAQUEL MONCRIEFFE
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Credential | OD
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Telephone | 561-451-0524
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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 | OPC 3494
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License Number State | FL
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