Provider Demographics
NPI:1578776035
Name:MAC UNLIMITED LLC
Entity Type:Organization
Organization Name:MAC UNLIMITED LLC
Other - Org Name:MOBILE VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CUSUMANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-300-7839
Mailing Address - Street 1:178 E DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3514
Mailing Address - Country:US
Mailing Address - Phone:813-300-7839
Mailing Address - Fax:813-425-9342
Practice Address - Street 1:178 E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3514
Practice Address - Country:US
Practice Address - Phone:813-300-7839
Practice Address - Fax:813-425-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2471251E00000X, 310400000X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC608OtherPROVIDER TRASACTION ACCES
FLU14263Medicare UPIN