Provider Demographics
NPI:1659557890
Name:VISION THE EYE CARE CENTER, PA
Entity Type:Organization
Organization Name:VISION THE EYE CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-228-8882
Mailing Address - Street 1:6320 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6104
Mailing Address - Country:US
Mailing Address - Phone:561-228-8882
Mailing Address - Fax:561-357-3387
Practice Address - Street 1:6320 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-6104
Practice Address - Country:US
Practice Address - Phone:561-228-8882
Practice Address - Fax:561-357-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9317OtherMEDICARE GROUP NUMBER