Provider Demographics
NPI:1922884220
Name:VISIONARY EYE SPECIALISTS LLC
Entity Type:Organization
Organization Name:VISIONARY EYE SPECIALISTS LLC
Other - Org Name:ST. LUCIE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-360-1732
Mailing Address - Street 1:702 SW PSL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2617
Mailing Address - Country:US
Mailing Address - Phone:703-499-3449
Mailing Address - Fax:
Practice Address - Street 1:702 SW PSL BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2617
Practice Address - Country:US
Practice Address - Phone:703-499-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty