Basic Information
| Provider Information | |||||||||
| NPI: | 1386203982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | ZENFIRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 928 W NEW HAVEN AVE | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329014241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548057550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 928 W NEW HAVEN AVE | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329014241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217284988 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2019 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC5685 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.