Provider Demographics
NPI:1770625691
Name:TOTAL VISION PA
Entity type:Organization
Organization Name:TOTAL VISION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-668-8885
Mailing Address - Street 1:2836 ENTERPRISE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-5210
Mailing Address - Country:US
Mailing Address - Phone:386-668-8885
Mailing Address - Fax:386-668-3301
Practice Address - Street 1:2836 ENTERPRISE RD STE 3
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5210
Practice Address - Country:US
Practice Address - Phone:386-668-8885
Practice Address - Fax:386-668-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620438400Medicaid
FLU70934Medicare UPIN
FL620438400Medicaid
FLCI7144Medicare PIN
FL1222680001Medicare NSC