Provider Demographics
NPI:1457761561
Name:THE ELITE VISION CARE, INC
Entity Type:Organization
Organization Name:THE ELITE VISION CARE, INC
Other - Org Name:ELITE VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-734-1887
Mailing Address - Street 1:3615 W WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7244
Mailing Address - Country:US
Mailing Address - Phone:561-734-1887
Mailing Address - Fax:561-736-8991
Practice Address - Street 1:3615 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7244
Practice Address - Country:US
Practice Address - Phone:561-734-1887
Practice Address - Fax:561-736-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620842800Medicaid
FLU69447Medicare UPIN
FLIB453AMedicare PIN
FL620842800Medicaid