Provider Demographics
NPI:1700275542
Name:VISIONCARE PROFESSIONALS PA
Entity Type:Organization
Organization Name:VISIONCARE PROFESSIONALS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-539-5895
Mailing Address - Street 1:1040 NE 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5565
Mailing Address - Country:US
Mailing Address - Phone:786-539-5895
Mailing Address - Fax:
Practice Address - Street 1:13600 SW 288TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1905
Practice Address - Country:US
Practice Address - Phone:786-539-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK714AOtherMEDICARE PTAN