Provider Demographics
NPI:1164870135
Name:MVRC INC
Entity Type:Organization
Organization Name:MVRC INC
Other - Org Name:MIRVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHESEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-437-9733
Mailing Address - Street 1:2909 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4212
Mailing Address - Country:US
Mailing Address - Phone:954-437-9733
Mailing Address - Fax:954-432-6116
Practice Address - Street 1:2909 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4212
Practice Address - Country:US
Practice Address - Phone:954-437-9733
Practice Address - Fax:954-432-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620519402Medicaid
FLQ0345Medicare PIN
FLT84133Medicare UPIN