Provider Demographics
NPI:1912097353
Name:DAYTONA VISION CENTER INC
Entity Type:Organization
Organization Name:DAYTONA VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-252-3619
Mailing Address - Street 1:733 DUNLAWTON AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-252-3619
Mailing Address - Fax:386-252-4429
Practice Address - Street 1:733 DUNLAWTON AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-252-3619
Practice Address - Fax:386-252-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC#002791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6093890001Medicare NSC