MEDICARE: VANMOR VISION PA

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	OPC4355	FL

General Provider Information

NPI Number	:	1942540406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANMOR VISION PA

Provider Business Mailing Address
First Line	:	4101 HUNTERS PARK LN
Second Line	:	UNIT 400
City	:	ORLANDO
State	:	FL
Zip	:	32837-3618
Country	:	US
Telephone Number	:	407-855-6132
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 HUNTERS PARK LN
Second Line	:	UNIT 400
City	:	ORLANDO
State	:	FL
Zip	:	32837-3618
Country	:	US
Telephone Number	:	407-855-6132
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VANESSA MARIE MORALES MCCANN
Credential	:	OD
Telephone Number	:	407-855-6132

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	09/19/2020

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