Provider Demographics
NPI:1356697064
Name:MOBILE VISION DOCTORS LLC
Entity type:Organization
Organization Name:MOBILE VISION DOCTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CARLO
Authorized Official - Last Name:VERXAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-439-2015
Mailing Address - Street 1:1315 SILK OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1367
Mailing Address - Country:US
Mailing Address - Phone:305-439-2015
Mailing Address - Fax:305-503-9250
Practice Address - Street 1:1315 SILK OAK DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1367
Practice Address - Country:US
Practice Address - Phone:305-439-2015
Practice Address - Fax:305-503-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3957152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194014845OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP
FL1851648026OtherNPI OF THE SAME BUSINESS BUT IN ANOTHER COUNTY (DADE)
FL024018600Medicaid
FL1124642269OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP
FL1528342631OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP
FL1669432969OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP
FL1700520608OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP
FL1851648026OtherNPI (SAME COMPANY, DIFFERENT COUNTY) DADE, FLORIDA
FL1831682178OtherNPI OF ONE OF THE PROVIDERS OF THE GROUP