MEDICARE: VISIONS UNLIMITED OPHTHALMIC, 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	OE 2124	FL

General Provider Information

NPI Number	:	1710394085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONS UNLIMITED OPHTHALMIC, LLC

Provider Business Mailing Address
First Line	:	1850 BOY SCOUT DR
Second Line	:	UNIT 107
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2127
Country	:	US
Telephone Number	:	239-931-0136
Fax Number	:	239-931-0910

Provider Business Practice Location Address
First Line	:	1850 BOY SCOUT DR
Second Line	:	UNIT 107
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2127
Country	:	US
Telephone Number	:	239-931-0136
Fax Number	:	239-931-0910

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RICHARD W. MCCOY
Credential	:	LDO
Telephone Number	:	239-931-0136

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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