Provider Demographics
NPI:1518106913
Name:GARDENS VISION CENTER P.A.
Entity Type:Organization
Organization Name:GARDENS VISION CENTER P.A.
Other - Org Name:LEAL VISION CENTER P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-626-9300
Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-626-9300
Mailing Address - Fax:
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-626-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBY187AMedicare PIN