MEDICARE: DIGIVISION CARE, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1689138265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGIVISION CARE, LLC

Provider Business Mailing Address
First Line	:	478 E ALTAMONTE DR STE 108-292
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 E ALTAMONTE DR
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4613
Country	:	US
Telephone Number	:	407-335-2950
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS DEVELOPMENT
Name	:	CHRISTOPHER J WHITEHURST
Credential	:
Telephone Number	:	321-972-1823

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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