MEDICARE: FLORIDA'S VISION QUEST, 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	152W00000X	Optometrist	OPC1293	FL

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	:	1336584176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA'S VISION QUEST, INC

Provider Business Mailing Address
First Line	:	167 N INDUSTRIAL DR
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7414
Country	:	US
Telephone Number	:	386-917-1001
Fax Number	:	386-917-1008

Provider Business Practice Location Address
First Line	:	167 N INDUSTRIAL DR
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7414
Country	:	US
Telephone Number	:	386-917-1001
Fax Number	:	386-917-1008

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. KELLY LYNN HAYNES
Credential	:
Telephone Number	:	386-917-1001

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	06/06/2016

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