Provider Demographics
NPI:1295970036
Name:ENVISION EYECARE & OPTIQUE
Entity type:Organization
Organization Name:ENVISION EYECARE & OPTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-621-8777
Mailing Address - Street 1:986 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1766
Mailing Address - Country:US
Mailing Address - Phone:772-621-8777
Mailing Address - Fax:
Practice Address - Street 1:986 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1766
Practice Address - Country:US
Practice Address - Phone:772-621-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBI356AMedicare PIN