Provider Demographics
NPI:1518390111
Name:VISION UNLIMITED PA
Entity Type:Organization
Organization Name:VISION UNLIMITED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-290-7676
Mailing Address - Street 1:3201 NE 183RD ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2486
Mailing Address - Country:US
Mailing Address - Phone:954-290-7676
Mailing Address - Fax:
Practice Address - Street 1:27499 RIVERVIEW CENTER BLVD
Practice Address - Street 2:SUITE 417
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4313
Practice Address - Country:US
Practice Address - Phone:954-290-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078801501Medicaid
FL20293AMedicare PIN