Provider Demographics
NPI:1790818466
Name:INNOVISION MEDICAL PA
Entity Type:Organization
Organization Name:INNOVISION MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GULANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-296-7393
Mailing Address - Street 1:8075 GATE PKWY W
Mailing Address - Street 2:SUITE 102 & 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3684
Mailing Address - Country:US
Mailing Address - Phone:904-296-7393
Mailing Address - Fax:904-296-0393
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:SUITE 102 & 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-296-7393
Practice Address - Fax:904-296-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1984070000152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty