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NPI Code Detail

MEDICARE: TOTAL VISION OF PORT ORANGE, INC.

MEDICARE: TOTAL VISION OF PORT ORANGE, 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
1152W00000XOptometrist

Other Identifiers

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

General Provider Information

NPI Number : 1598984676
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOTAL VISION OF PORT ORANGE, INC.
Provider Business Mailing Address
First Line : 5820 S WILLIAMSON BLVD STE 106
Second Line :
City : PORT ORANGE
State : FL
Zip : 32128-6400
Country : US
Telephone Number : 386-767-4449
Fax Number : 386-767-1980
Provider Business Practice Location Address
First Line : 5820 S WILLIAMSON BLVD STE 106
Second Line :
City : PORT ORANGE
State : FL
Zip : 32128-6400
Country : US
Telephone Number : 386-767-4449
Fax Number : 386-767-1980
Authorized Official
Title or Position : OWNER
Name : DR. PHILLIP L STEPHENS
Credential : O.D.
Telephone Number : 386-767-4449
Provider Enumeration Date : 04/25/2007
Last Update Date : 10/22/2009

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Directions to “TOTAL VISION OF PORT ORANGE, INC. ” Practice Location

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