MEDICARE: THE VISION HUB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WP0200X	Pediatric Optometrist
3	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XB20D	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720652316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VISION HUB LLC

Provider Business Mailing Address
First Line	:	770 US HIGHWAY 331 S STE 1
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-3307
Country	:	US
Telephone Number	:	850-892-5514
Fax Number	:	850-200-4373

Provider Business Practice Location Address
First Line	:	770 US HIGHWAY 331 S STE 1
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-3307
Country	:	US
Telephone Number	:	850-892-5514
Fax Number	:	850-892-0189

Authorized Official
Title or Position	:	CREDENTIALIST
Name	:	CHRISTAL ROCERETO
Credential	:
Telephone Number	:	850-542-5133

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	03/15/2024

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Directions to “THE VISION HUB LLC ” Practice Location

Language	Start Address	Practice Location

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