Provider Demographics
NPI:1922362359
Name:GENERATION ONE INC
Entity Type:Organization
Organization Name:GENERATION ONE INC
Other - Org Name:ADVANCED VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENVENUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD - OPHTHALMOLOGY
Authorized Official - Phone:561-687-1414
Mailing Address - Street 1:2532 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4006
Mailing Address - Country:US
Mailing Address - Phone:561-687-1414
Mailing Address - Fax:561-697-4445
Practice Address - Street 1:2532 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4006
Practice Address - Country:US
Practice Address - Phone:561-687-1414
Practice Address - Fax:561-697-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4886156FX1800X
FLDO6145156FX1800X
FLME94259207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty