Provider Demographics
NPI:1669855722
Name:EYE DEAL VISION LLC
Entity Type:Organization
Organization Name:EYE DEAL VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISDRAJI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-738-0112
Mailing Address - Street 1:6641 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3527
Mailing Address - Country:US
Mailing Address - Phone:561-738-0112
Mailing Address - Fax:
Practice Address - Street 1:7092 BRUNSWICK CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2533
Practice Address - Country:US
Practice Address - Phone:561-252-2558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU59634Medicare UPIN