Provider Demographics
NPI:1750746095
Name:MOBILE VISION PARTNERS, P.L.L.C.
Entity type:Organization
Organization Name:MOBILE VISION PARTNERS, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:844-789-2020
Mailing Address - Street 1:2451 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1356
Mailing Address - Country:US
Mailing Address - Phone:844-789-2020
Mailing Address - Fax:844-789-2020
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD STE 201
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1362
Practice Address - Country:US
Practice Address - Phone:844-789-2020
Practice Address - Fax:844-789-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017249400Medicaid
FLIU453AMedicare PIN