Provider Demographics
NPI:1457308322
Name:VISION ONE INC
Entity Type:Organization
Organization Name:VISION ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-274-5525
Mailing Address - Street 1:1900 MASON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5103
Mailing Address - Country:US
Mailing Address - Phone:386-274-5525
Mailing Address - Fax:386-274-5585
Practice Address - Street 1:1900 MASON AVE STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5103
Practice Address - Country:US
Practice Address - Phone:386-274-5525
Practice Address - Fax:386-274-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620222500Medicaid
FL1170460004Medicare NSC
FL1170460003Medicare NSC
FLK0149AMedicare PIN
FL1170460002Medicare NSC
FL1170460001Medicare NSC
FLK0149BMedicare PIN
FLK0149Medicare PIN