Provider Demographics
NPI:1710394085
Name:VISIONS UNLIMITED OPHTHALMIC, LLC
Entity type:Organization
Organization Name:VISIONS UNLIMITED OPHTHALMIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:239-931-0136
Mailing Address - Street 1:1850 BOY SCOUT DR
Mailing Address - Street 2:UNIT 107
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2127
Mailing Address - Country:US
Mailing Address - Phone:239-931-0136
Mailing Address - Fax:239-931-0910
Practice Address - Street 1:1850 BOY SCOUT DR
Practice Address - Street 2:UNIT 107
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2127
Practice Address - Country:US
Practice Address - Phone:239-931-0136
Practice Address - Fax:239-931-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 2124332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier