MEDICARE: DV EYE CENTER, 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	OPC 3789	FL

General Provider Information

NPI Number	:	1396053237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DV EYE CENTER, LLC

Provider Business Mailing Address
First Line	:	4413 HOFFNER AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-2331
Country	:	US
Telephone Number	:	407-207-5310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 HOFFNER AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-2331
Country	:	US
Telephone Number	:	407-207-5310
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. VINCENT MINH DO
Credential	:	O.D.
Telephone Number	:	407-207-5310

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	01/22/2015

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