Basic Information
| Provider Information | |||||||||
| NPI: | 1821016569 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAL-U-VISION INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VAL-U-VISION OF REGENCY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 ATLANTIC BLVD | ||||||||
| Address2: | SUITE 62 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322258255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047217700 | ||||||||
| FaxNumber: | 9047210051 | ||||||||
| Practice Location | |||||||||
| Address1: | 9400 ATLANTIC BLVD | ||||||||
| Address2: | SUITE 62 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322258255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047217700 | ||||||||
| FaxNumber: | 9047210051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RAUCHWARGER | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9047217700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620552600 | 05 | FL | MEDICAID | 45648 | 01 | FL | BCBS | OTHER |