Basic Information
| Provider Information | |||||||||
| NPI: | 1730681305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY VISION CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6280 W SAMPLE RD STE 202 | ||||||||
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| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613223588 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 N UNIVERSITY DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613223588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | CANNON | ||||||||
| AuthorizedOfficialFirstName: | SHATINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613223588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.