MEDICARE: VASCU VISION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HCC4566	FL

General Provider Information

NPI Number	:	1013003532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASCU VISION INC

Provider Business Mailing Address
First Line	:	12794 W. FOREST HILL BLVD.
Second Line	:	SUITE 30
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-795-6868
Fax Number	:	561-795-6869

Provider Business Practice Location Address
First Line	:	12794 W. FOREST HILL BLVD.
Second Line	:	SUITE 30
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-795-6868
Fax Number	:	561-795-6869

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARCIA ELAINE ROY
Credential	:	RT,RDMS,RVT,RDCS,CCT
Telephone Number	:	561-795-6868

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/28/2015

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