Provider Demographics
NPI:1710336961
Name:VAN EYE OPTOMETRY
Entity Type:Organization
Organization Name:VAN EYE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-558-9965
Mailing Address - Street 1:9982 GLADES RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3913
Mailing Address - Country:US
Mailing Address - Phone:561-558-9965
Mailing Address - Fax:561-558-9512
Practice Address - Street 1:9982 GLADES RD
Practice Address - Street 2:SUITE G1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3913
Practice Address - Country:US
Practice Address - Phone:561-558-9965
Practice Address - Fax:561-558-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty