Provider Demographics
NPI:1366849051
Name:ENVOLVE VISION OF FLORIDA, INC.
Entity Type:Organization
Organization Name:ENVOLVE VISION OF FLORIDA, INC.
Other - Org Name:OCUCARE SYSTEMS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-544-9200
Mailing Address - Street 1:112 ZEBULON COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2420
Mailing Address - Country:US
Mailing Address - Phone:800-334-3937
Mailing Address - Fax:888-986-2823
Practice Address - Street 1:112 ZEBULON COURT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2420
Practice Address - Country:US
Practice Address - Phone:800-334-3937
Practice Address - Fax:888-986-2823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENCORP HEALTH SOLUTIONS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-25
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service