MEDICARE: VISION FIRST FLORIDA LLC

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

General Provider Information

NPI Number	:	1265291140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION FIRST FLORIDA LLC

Provider Business Mailing Address
First Line	:	6595 S FLORIDA AVE STE 3
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 S FLORIDA AVE STE 3
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3316
Country	:	US
Telephone Number	:	863-398-2454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DUSTIN J DIXON
Credential	:	OD
Telephone Number	:	863-398-2455

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “VISION FIRST FLORIDA LLC ” Practice Location

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