MEDICARE: ROLE MODEL VISION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1801366786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLE MODEL VISION LLC

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-3276
Country	:	US
Telephone Number	:	404-984-6038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 S HIAWASSEE RD APT 4624
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8768
Country	:	US
Telephone Number	:	404-984-6038
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT L RELEFORD JR.
Credential	:
Telephone Number	:	404-984-6038

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	05/26/2021

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