Provider Demographics
NPI:1831376953
Name:MAITLAND VISION CENTER
Entity type:Organization
Organization Name:MAITLAND VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:WILLSON
Authorized Official - Last Name:YEILDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-647-2020
Mailing Address - Street 1:600 S ORLANDO AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5660
Mailing Address - Country:US
Mailing Address - Phone:407-647-2020
Mailing Address - Fax:
Practice Address - Street 1:600 S ORLANDO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5660
Practice Address - Country:US
Practice Address - Phone:407-647-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00349Medicare PIN