MEDICARE: WORLD VISION CENTERS II INC

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	:	1891771580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORLD VISION CENTERS II INC

Provider Business Mailing Address
First Line	:	4927 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4927 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2829
Country	:	US
Telephone Number	:	954-985-1211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUSK S HARRIS
Credential	:
Telephone Number	:	954-985-1211

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/22/2020

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