Provider Demographics
NPI:1720064405
Name:WORLD VISION CENTER I
Entity Type:Organization
Organization Name:WORLD VISION CENTER I
Other - Org Name:WORLD VISION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-575-9934
Mailing Address - Street 1:1251 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8313
Mailing Address - Country:US
Mailing Address - Phone:954-575-9934
Mailing Address - Fax:
Practice Address - Street 1:1251 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8313
Practice Address - Country:US
Practice Address - Phone:954-575-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51266Medicare UPIN
FLE3381YMedicare ID - Type UnspecifiedINDIVIDUAL RICHARD BERMAN
FLU77994Medicare UPIN
FL20612BMedicare ID - Type UnspecifiedINDIVIDUAL/ RUSK HARRIS
FLK2913Medicare ID - Type UnspecifiedGROUP