Provider Demographics
NPI:1740455526
Name:EYE CLINIC OF VERO INC
Entity type:Organization
Organization Name:EYE CLINIC OF VERO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-567-6513
Mailing Address - Street 1:634 21ST ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0933
Mailing Address - Country:US
Mailing Address - Phone:772-567-6513
Mailing Address - Fax:772-567-6993
Practice Address - Street 1:634 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0933
Practice Address - Country:US
Practice Address - Phone:772-567-6513
Practice Address - Fax:772-567-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3442332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4457280001Medicare NSC