Provider Demographics
NPI:1912210006
Name:GROOM VISION CENTER
Entity Type:Organization
Organization Name:GROOM VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYISICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-597-5700
Mailing Address - Street 1:3455 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3824
Mailing Address - Country:US
Mailing Address - Phone:239-597-5700
Mailing Address - Fax:239-597-3500
Practice Address - Street 1:3455 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3824
Practice Address - Country:US
Practice Address - Phone:239-597-5700
Practice Address - Fax:239-597-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty