Provider Demographics
NPI:1013003532
Name:VASCU VISION INC
Entity type:Organization
Organization Name:VASCU VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:RT,RDMS,RVT,RDCS,CCT
Authorized Official - Phone:561-795-6868
Mailing Address - Street 1:12794 W. FOREST HILL BLVD.
Mailing Address - Street 2:SUITE 30
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4710
Mailing Address - Country:US
Mailing Address - Phone:561-795-6868
Mailing Address - Fax:561-795-6869
Practice Address - Street 1:12794 W. FOREST HILL BLVD.
Practice Address - Street 2:SUITE 30
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-795-6868
Practice Address - Fax:561-795-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4566261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1301Medicare ID - Type Unspecified