Provider Demographics
NPI:1568769701
Name:CAPITAL VISION CARE INC.
Entity Type:Organization
Organization Name:CAPITAL VISION CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-490-0326
Mailing Address - Street 1:13210 SW 19TH DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3431
Mailing Address - Country:US
Mailing Address - Phone:305-490-0326
Mailing Address - Fax:
Practice Address - Street 1:11401 PINES BLVD
Practice Address - Street 2:SUITE 352
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4117
Practice Address - Country:US
Practice Address - Phone:954-438-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty