Provider Demographics
NPI:1710063045
Name:DOVER VISION CENTRE LTD
Entity Type:Organization
Organization Name:DOVER VISION CENTRE LTD
Other - Org Name:VISION CENTREOPTICAL LLC /VISION CENTRE LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTICAL TECH BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-934-6620
Mailing Address - Street 1:232 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-9412
Mailing Address - Country:US
Mailing Address - Phone:302-934-6620
Mailing Address - Fax:302-934-7386
Practice Address - Street 1:18791 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4401
Practice Address - Country:US
Practice Address - Phone:302-645-1800
Practice Address - Fax:302-644-0242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION CENTRE OPTICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-30
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0626430002Medicare NSC