MEDICARE: INNOVISION PRACTICE GROUP PA

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	:	1619153947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVISION PRACTICE GROUP PA

Provider Business Mailing Address
First Line	:	PO BOX 3365
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33775-3365
Country	:	US
Telephone Number	:	727-489-0500
Fax Number	:	727-489-0508

Provider Business Practice Location Address
First Line	:	3202 W KENNEDY BLVD STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3245
Country	:	US
Telephone Number	:	813-879-2020
Fax Number	:	813-872-0720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK J SARNO
Credential	:	O.D.
Telephone Number	:	727-489-0500

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	09/25/2008

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Directions to “INNOVISION PRACTICE GROUP PA ” Practice Location

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