Provider Demographics
NPI:1013193499
Name:VENICE VISION CENTER, INC
Entity Type:Organization
Organization Name:VENICE VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:941-485-7316
Mailing Address - Street 1:200 PALERMO PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2820
Mailing Address - Country:US
Mailing Address - Phone:941-485-7316
Mailing Address - Fax:941-486-0571
Practice Address - Street 1:200 PALERMO PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2820
Practice Address - Country:US
Practice Address - Phone:941-485-7316
Practice Address - Fax:941-486-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE0000334332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0595790001Medicare NSC