Provider Demographics
NPI:1144741455
Name:POH VERO BEACH LLC
Entity Type:Organization
Organization Name:POH VERO BEACH LLC
Other - Org Name:WORLD OF VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROITORESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-2020
Mailing Address - Street 1:2320 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1525
Mailing Address - Country:US
Mailing Address - Phone:305-649-4011
Mailing Address - Fax:
Practice Address - Street 1:530 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5450
Practice Address - Country:US
Practice Address - Phone:772-562-2020
Practice Address - Fax:772-562-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5603156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO5603OtherOPTICIAN