Provider Demographics
NPI:1861859571
Name:IMPERIAL VISION CENTER, INC
Entity Type:Organization
Organization Name:IMPERIAL VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCRIEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-451-0524
Mailing Address - Street 1:19605 STATE ROAD 7 STE D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4767
Mailing Address - Country:US
Mailing Address - Phone:561-451-0524
Mailing Address - Fax:561-451-0788
Practice Address - Street 1:19605 STATE ROAD 7 STE D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4767
Practice Address - Country:US
Practice Address - Phone:561-451-0524
Practice Address - Fax:561-451-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty