Provider Demographics
NPI:1033283288
Name:VISION SOURCE OVIEDO, INC
Entity Type:Organization
Organization Name:VISION SOURCE OVIEDO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-971-1001
Mailing Address - Street 1:1020 LOCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6027
Mailing Address - Country:US
Mailing Address - Phone:407-971-1001
Mailing Address - Fax:407-971-1002
Practice Address - Street 1:1020 LOCKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6027
Practice Address - Country:US
Practice Address - Phone:407-971-1001
Practice Address - Fax:407-971-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621240900Medicaid
FL5681560001Medicare NSC
FLU5068AMedicare ID - Type Unspecified
FL621240900Medicaid
FLK7921Medicare PIN