MEDICARE: BLUE VISION CORPORATION

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	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205199916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE VISION CORPORATION

Provider Business Mailing Address
First Line	:	1558 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3810
Country	:	US
Telephone Number	:	305-556-0272
Fax Number	:	305-207-0301

Provider Business Practice Location Address
First Line	:	1558 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3810
Country	:	US
Telephone Number	:	305-556-0272
Fax Number	:	305-207-0301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIA ANTONIA MESA
Credential	:
Telephone Number	:	305-556-0272

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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Directions to “BLUE VISION CORPORATION ” Practice Location

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